Prospective, randomized clinical trial of cataract surgery patients with obstructive MGD - of course, the ones who were treated for it pre-operatively fared better as regards their MGD status.
Probing and other MGD points of interest at AAO 2019
How dead is dead? (And other MGD highlights from AAO 2019)
Study: Four subtypes of MGD
Study: Heat & squeeze, and Eyepeace or fingers
Study: Relationship between type 2 diabetes and dry eye, MGD
Study: IPL... again...
Yup, it’s the third IPL paper I’ve come across tonight in going through just two weeks of study alerts.
Showed improvements to tear break-up time and OSDI symptom scores; younger patients had better results than older patients.
Intense Pulsed Light Treatment for Meibomian Gland Dysfunction in Skin Types III/IV. Li D et al, Photobiomodul Photomed Laser Surg. 2019 Feb
Background and objective: Several cases of meibomian gland dysfunction (MGD), particularly the moderate to severe ones, are considered intractable by traditional therapy. Intense pulsed light (IPL) therapy has emerged as a new choice for management of MGD in recent years, given that use of lasers and optical treatments is typically challenging in patients with darker skin types. Methods: IPL treatment for MGD is administered in the periorbital area with the thinnest skin in our body, which has an inherent risk of skin side effects. We evaluated the effects and safety of this therapy in Chinese patients with Fitzpatrick skin types III-IV. Forty MGD patients were randomly administered IPL treatment with two types of parameters in the left and the right eye. Results: Results revealed that both parameter settings of IPL treatment could gradually and effectively raise the tear breakup time (BUT) and ocular surface disease index (OSDI) score. However, younger patients showed better improvement in BUT (F = 19.54, p < 0.01) and OSDI (F = 9.93, p < 0.01) compared with older patients. Conclusions: Overall, results showed that IPL treatment is safe and effective in MGD patients with skin types III-IV.
Study: Why they need to get the diagnosis right in the first place
Study: Treat MGD before cataract surgery to prevent worsening
We’re seeing more, and more, and more about this, and it’s a good trend. It’s not just about “dry eye” in general, it’s honing in on MGD.
Remember all those years when LASIK patients who got MGD afterwards had no answers? To see discussion of MGD in even a cataract surgery context now lends even more credibility to the reality of our experiences. Who knows how many of us may have had undiagnosed MGD flying under the radar before an eye surgery. It’s good to see standards slowly improving. Visual outcomes are still probably the main thing driving the trend, but preventing a worsening of dry eye or MGD is a good thing whatever drives it and that is exactly what this particular study focuses on.
Preoperative Management of MGD Alleviates the Aggravation of MGD and Dry Eye Induced by Cataract Surgery: A Prospective, Randomized Clinical Trial. Song et al, Biomed Res Int. 2019 Apr 11
Abstract
PURPOSE:
To investigate the effect of preoperative treatment and postoperative enhanced anti-inflammatory treatment on alleviating meibomian gland dysfunction (MGD) and dry eye induced by cataract surgery.
DESIGN:
Prospective, randomized clinical trial.
METHODS:
A total of 120 cataract patients with moderate obstructive-MGD were enrolled and randomized with 60:30:30 number of patients in cohorts I, II, and III, respectively: Cohort I: routine postoperative anti-inflammatory treatment; Cohort II: preoperative treatment (warming compress, lid hygiene, and anti-inflammatory treatment) and routine postoperative anti-inflammatory treatment; Cohort III: enhanced postoperative anti-inflammatory treatment.
MAIN OUTCOMES MEASURES:
All participants were examined preoperatively and postoperatively for ocular symptom score (OSS), noninvasive keratographic tear break-up time (NIKBUT), corneal fluorescein staining, Schirmer I test, lid margin, meibum quality and expressibility, and meibomian gland dropout.
RESULTS:
Ocular surface disorders and MGD showed aggravated status at 1 month postoperatively in Cohort I and Cohort III, and the aggravated MGD resolved by 3 months postoperatively. At 1 month postoperatively, Cohort II and Cohort III presented high NIKBUT and low OSS, lid margin, and meibum quality and expressibility (Cohort II vs Cohort I: all P<0.001, respectively; Cohort III vs Cohort I: P=0.011, P=0.024, P=0.046, P=0.045, and P=0.012, respectively). Additionally, Cohort II had better outcomes of lid margin and meibum quality and expressibility than Cohort III at 1 month postoperatively (P=0.031, P=0.026, and P<0.001, respectively). At 3 months postoperatively, Cohort II presented a significantly higher NIKBUT than Cohort I and Cohort III (P<0.001 and P=0.001, respectively).
CONCLUSION:
Preoperative management of MGD is effective and optimal in alleviating obstructive-MGD and dry eye induced by cataract surgery.
Oral azythromycin vs doxycycline for MGD
Study: MGD vs dry eye (population study)
IPL for stubborn MGD
iLux: Heat & squeeze
TearCare: Wearable warm compresses
Abstract: Critiquing a compress
Of forests, trees, dry eye, and meibomian glands: Have you lost the plot?
Study: Measuring MGD non-invasively
This MGD diagnosis study is really quite interesting, because the data essentially flip-flop depending whether you're looking at an "either-or" or an "and". The bottom line seems to be, MGD is NOT a simple equation: sophisticated, qualitative tests are needed for accurately and specifically diagnosing MGD.
MGD epidemiological study
This study looked at records of 1372 dry eye patients in Austria.
Couple of noteworthy highlights:
70% of the patients had signs of MGD.
The patients with "pure" MGD LOOKED better (clinically) but FELT just as bad as patients with aqueous deficient dry eye (with or without MGD) or sjogrens.
Acta Ophthalmol. 2018 Apr 15. doi: 10.1111/aos.13732. [Epub ahead of print]
The prevalence of meibomian gland dysfunction, tear film and ocular surface parameters in an Austrian dry eye clinic population.
Rabensteiner DF1, Aminfar H1, Boldin I1, Schwantzer G2, Horwath-Winter J1.
Abstract
PURPOSE:
The purpose of this study was to assess the prevalence of meibomian gland dysfunction (MGD) and its association with tear film and ocular surface parameters in an Austrian clinical population of dry eye patients.
METHODS:
The records of 1372 consecutive patients from a dry eye unit were analysed retrospectively. Symptoms and objective tear film and ocular surface parameters were evaluated. Patients were classified into pure MGD, pure aqueous tear deficiency (ATD), MGD combined with ATD, pure anterior blepharitis (AB), Sjogren's syndrome (SS) without MGD and SS together with MGD.
RESULTS:
Nine-hundred and sixty-five patients, that is 70.3% of the investigated population, mean age 55.4 ± 16.6 years, had signs of MGD. Of these, 684 (70.9%) were female. The intensity of symptoms did not differ between subgroups. Four hundred and ninety (50.8%) MGD patients had Schirmer test values ≤10 mm/5 min. The fluorescein break-up time and Schirmer test values were significantly higher in the pure AB and MGD group. The pure MGD group showed a significantly lower fluorescein staining of the cornea compared to the other groups, except for pure AB. Lissamine green staining of the ocular surface was present in all groups, but was at least pronounced in the pure MGD and AB group.
CONCLUSION:
Meibomian gland dysfunction is a major cause of ocular discomfort and could often be found in combination with a reduced aqueous tear secretion. Although the intensity of subjective complaints was similar to all other subgroups, pure MGD exhibited the lowest severity of signs of ocular surface damage and also affected younger people.