title: Effects of topical loteprednol etabonate on tear cytokines and clinical outcomes in moderate and severe meibomian gland dysfunction: randomized clinical trial.
abstract: OBJECTIVE
  To assess tear cytokine levels and clinical outcomes in moderate and severe meibomian gland dysfunction (MGD) after 2 months of treatment with topical loteprednol etabonate and eyelid scrubs with warm compresses vs eyelid scrubs with warm compresses alone.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Patients with moderate and severe MGD were randomized into 2 groups: topical loteprednol etabonate and eyelid scrubs with warm compresses (Group I, 34 eyes) or eyelid scrubs with warm compresses (Group II, 36 eyes). We evaluated cytokine levels, tear film break-up time (TBUT), corneal and conjunctival fluorescein staining, biomicroscopic examination of lid margins and meibomian glands, and the Ocular Surface Disease Index before initiating treatment and 1 month and 2 months after treatment.
  
  
  RESULTS
  There were significant decreases in the levels of interleukin (IL)-6, IL-8, and IL-1β in Group I, and IL-6 and IL-8 in Group II. Moreover, the observed decreases of these cytokines in Group I were attributed to a remarkable decrease between treatment and 1 month after treatment. In Group I, there were improvements in all of the clinical outcomes, with prominent improvement in TBUT, corneal and conjunctival fluorescein staining, and meibum quality after 1 month of treatment, compared with Group II. An improvement in meibomian gland expressibility and MGD stage reduction were more remarkable in Group I.
  
  
  CONCLUSIONS
  Topical loteprednol etabonate and eyelid scrubs with warm compresses were tolerated and efficacious for the treatment of moderate and severe MGD. We suggest that such beneficial effects could manifest after 1 month.
authors.affiliation: Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Hun
authors.initials: H
authors.lastname: Lee
authors.affiliation: Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Byunghoon
authors.initials: B
authors.lastname: Chung
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Kyu Seo
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Kyoung Yul
authors.initials: KY
authors.lastname: Seo
authors.affiliation: Lee Eye Clinic, Busan, South Korea.
authors.forename: Bong Joon
authors.initials: BJ
authors.lastname: Choi
authors.affiliation: Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: tikim@yuhs.ac.
authors.forename: Tae-Im
authors.initials: TI
authors.lastname: Kim
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000730:Androstadienes / Q000008:administration & dosage / Q000627:therapeutic use*; D018926:Anti-Allergic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001458:Bandages; D016207:Cytokines / Q000378:metabolism*; D005136:Eye Proteins / Q000378:metabolism*; D005141:Eyelid Diseases / Q000145:classification / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D000069559:Loteprednol Etabonate; D008297:Male; D008537:Meibomian Glands / Q000187:drug effects* / Q000378:metabolism; D008875:Middle Aged; D009883:Ophthalmic Solutions; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013666:Tears / Q000378:metabolism*
chemical_list: D000730:Androstadienes; D018926:Anti-Allergic Agents; D016207:Cytokines; D005136:Eye Proteins; D009883:Ophthalmic Solutions; C042434:tear proteins; D000069559:Loteprednol Etabonate