title: Combination Therapy of Intense Pulsed Light Therapy and Meibomian Gland Expression (IPL/MGX) Can Improve Dry Eye Symptoms and Meibomian Gland Function in Patients With Refractory Dry Eye: A Retrospective Analysis.
abstract: OBJECTIVE
  To assess the improvement in meibomian gland function and dry eye symptoms in patients with refractory dry eye treated with a combination therapy of intense pulsed light (IPL) and meibomian gland expression (MGX).
  
  
  METHODS
  Medical records of 81 consecutive patients with dry eye treated with serial IPL/MGX were retrospectively examined to determine the outcome. All patients had a minimum of 6 months of follow-up after the first IPL/MGX treatment. Patients typically received 1 to 4 IPL treatments spaced 4 to 6 weeks apart. Each IPL session included MGX. Thirty-five charts had complete data for inclusion in analysis. We reviewed demographics, ocular histories, Standard Patient Evaluation of Eye Dryness 2 (SPEED2) symptom survey scores, slit-lamp examinations, and meibomian gland evaluations (MGE) at baseline and at each visit before IPL/MGX treatments.
  
  
  RESULTS
  The paired t test showed a significant (P < 0.0001) decrease in SPEED2 with IPL/MGX therapy. Of the 35 patients, 8 (23%) had a ≥50% decrease in SPEED2, 23 (66%) had a 1% to 49% decrease in SPEED2, 1 (3%) had no change in SPEED2, and 3 (9%) had an increase in SPEED2. The Paired t test showed a significant increase in MGE in the left eye but not in the right eye (OD P = 0.163 and OS P = 0.0002). Thirteen patients (37%) had improved MGE bilaterally. Eight patients (23%) had either a decrease in MGE bilaterally or a decrease in 1 eye with no change in the other eye.
  
  
  CONCLUSIONS
  This retrospective analysis shows that the combination of IPL and MGX can significantly improve dry eye symptoms (in 89% of patients) and meibomian gland function (in 77% of patients in at least 1 eye).
authors.affiliation: *University of Arizona College of Medicine-Phoenix, Phoenix, AZ; and †Department of Ophthalmology, Mayo Clinic, Scottsdale, AZ.
authors.forename: Sravanthi
authors.initials: S
authors.lastname: Vegunta
authors.forename: Dharmendra
authors.initials: D
authors.lastname: Patel
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Shen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy / Q000379:methods; D015352:Dry Eye Syndromes / Q000628:therapy*; D005260:Female; D006801:Humans; D062325:Intense Pulsed Light Therapy; D008297:Male; D008537:Meibomian Glands / Q000378:metabolism* / Q000503:physiopathology; D008875:Middle Aged; D011312:Pressure; D012044:Regression Analysis; D012189:Retrospective Studies; D013666:Tears / Q000378:metabolism; D064746:Therapy, Soft Tissue / Q000379:methods*; D055815:Young Adult