Comparison Of Azithromycin And Loteprednol Etabonate And Tobramycin Eye Drops In The Treatment Of Meibomian Gland Dysfunction

Objectives To compare the efficacy and safety of oral azithromycin and local application of loteprednol etabonate and tobramycin eye drops in the treatment of moderate and severe meibomian gland dysfunction.Methods This study was a randomized controlled concurrent trial.100 eyes of 100 patients with moderate and severe meibomian gland dysfunction in the department of kailuan general hospital from 2016-10 to 2017-07 were randomized into group 1 and group 2: group 1(50 eyes of 50 patients)was treated with azithromycin dispersible tablets for 5 days,500 mg on day 1,250 mg daily from day 2 to day 5;Group 2(50 eyes of 50 patients)was treated with local application of loteprednol etabonate and tobramycin eye drops 4 times a day for 1 months,at the same time,both groups combined with physical therapy of eye warm compresses massages and eyelid scrubs,sodium hyaluronate eye drops as a regular basis therapy for 1 months.Followed up at 1 days before the treatment,2 weeks,4 weeks and 8 weeks after treatment,the patients filled out the questionnairs to complete six symptoms scores of eye dryness,eye redness,eye itching,foreign body sensation,burning sensation,volatility blurred vision;the researchers evaluated 9 signs scores of S?T,FBUT,FL,ML,IOP,eyelid margin shape change,meibomian gland orifices obstruction,meibomian gland secretion state,meibum traits,and recorded the drug had any adverse reaction.To evaluate and compare the efficacy and safety of the two treatments,S-w test,t-test,chi-square test,and two factors repeated measurement of variance analysis were used to analyze statistical data.Results In Group 1,there were no significant differences in the S?T or IOP data before and after treatment(P>0.05),and all the other clinical symptoms and signs differences were significant(P<0.001).In Group 2,there were no significant differences between the S?T data before and after treatment(P>0.05),and all the other clinical symptoms and signs differences were significant(P<0.001).The IOP difference before and after the treatment in group 2 was statistically significant(P<0.001),4 weeks after treatment than before treatment was the largest,significantly increased 1.64(95% CI: 1.276-2.007)mm Hg(P<0.001),but less than physiological IOP fluctuation daily 5 mm Hg,so without clinical significance.FBUT of two groups after treatment significantly increased over time,each other observation index scores except S?T and IOP,were significantly decreased over time.The differences in FBUT before and after treatment at each time point of follow-up were significant(P<0.001),and FBUT in both groups showed an increasing trend within 8 weeks after treatment.Symptoms total scores,meibomian gland total scores and FL scores differences of group 1 between 4 weeks and 8 weeks after treatment had no significance(P>0.05),the rest of the time differences had significance(P<0.001),the effect of the decrease reached its peak at 4 weeks after treatment,and then the effect leveled off.While those of group 2 before and after treatment at each time point of follow-up were all significant(P<0.05),which showed a continuous decreasing trend in 8 weeks after treatment.The three index differences of eye redness,eye itching and eyelid edge shape change between 2 groups were significant(P=0.008<0.05,P<0.001,P<0.001),group 2 decreased more significantly than group 1.The difference of eye redness,eye itching and eyelid edge shape score between the two groups at 2 weeks,4 weeks,8 weeks after treatment have significance(eye redness P<0.05,the rest P<0.001),the difference of total symptom scores between the two groups at 2 weeks,8 weeks after treatment have significance(P=0.033<0.05,P=0.019<0.05),the difference of meibomian gland total score between the two groups at 8 weeks after treatment was significant(P=0.012<0.05),group 2 decreased more significantly than group 1.Conclusions Both Oral azithromycin combined with artificial tears and physical therapy and loteprednol etabonate and tobramycin eye drops combined with artificial tears and physical therapy are effective methods to treat moderate and severe meibomian gland dysfunction,and no obvious adverse reactions.The former has a peak value about at 4 weeks after treatment,while the latter relieves the symptoms fairly quickly,and the peak effect may be at 8 weeks or 8 weeks later after treatment.The effect of loteprednol etabonate and tobramycin eye drops is better than azithromycin in alleviating the symptoms of eye redness,eye itching and improving the morphology of eyelid margin.