Short-term Efficacy Of Intense Pulsed Light Combined With 0.05% Cyclosporine A Eye Drops In The Treatment Of Dry Eyes Associated With Moderate And Severe Meibomian Gland Dysfunction

Objective To observe the short-term efficacy of intense pulsed light(IPL)combined with 0.05% cyclosporine A(Cs A)eye drops in the treatment of moderate and severe meibomian gland dysfunction(MGD)-related dry eyes,and to provide evidence for clinical treatment of moderate and severe MGD-related dry eyes.Methods 61 patients(122 eyes)with moderate and severe MGD-related dry eyes in Ophthalmology department of Subei People’s Hospital from May 2022 to December 2022 were enrolled.The patients were divided into IPL group,Cs A group,combined group(IPL combined with Cs A)and control group.Except for 16 cases(32 eyes)in IPL group,15 cases(30 eyes)in other groups.The changes of subjective symptoms and objective examination indexes of dry eyes in the four groups were observed and compared before treatment and 2and 4 weeks after treatment.Subjective symptom indicators include: ocular surface disease index(OSDI)questionnaire,standard patient evaluation of eye dryness(SPEED)questionnaire;Objective examination indexes include Schirmer I test(SIT),non-invasive tear meniscus height(NITMH),corneal fluorescein staining(CFS),fluorescein break up time(FBUT),meibomian gland loss score,and palpebral margin score.The intra-group comparison was performed by One-way Repeated Measures Anova or Friedman test,and the inter-group comparison was performed by One-way Anova or Kruskal-Wallis H test.Results 1.Intra-group comparison before and after treatment in each group1.1 In IPL group: After 2 weeks and 4 weeks of treatment,then OSDI and SPEED scores of patients in IPL group were significantly improved compared with those before treatment(P<0.05),FBUT was significantly higher than that before treatment(P<0.05),the palpebral margin score was significantly lower than that before treatment;in addition,4 weeks after treatment,CFS were significantly lower than before treatment(P<0.05),the score of upper eyelid and lower eyelid meibomian gland loss in IPL group was significantly lower than that before treatment(P<0.05);1.2 In Cs A group: After 2 weeks and 4 weeks of treatment,the OSDI and SPEED scores of patients in the Cs A group were significantly lower than those before treatment(P<0.05),SIT and NITMH were significantly higher than before treatment(P<0.05),FBUT is significantly higher than before treatment(P<0.05);in addition,4 weeks after treatment,the eyelid margin score of patients in the cyclosporine group was significantly lower than that before treatment(P<0.05);1.3 In combined group: After 2 weeks and 4 weeks of treatment,the OSDI and SPEED scores of patients in the combined group were significantly lower than those before treatment(P<0.05),NITMH increased significantly compared with that before treatment(P<0.05),FBUT is significantly higher than before treatment(P<0.05),the palpebral margin score decreased significantly compared with that before treatment(P<0.05);in addition,four weeks after treatment,the SIT of patients in the combination group was significantly higher than that before treatment(P<0.05),CFS in the combination group was significantly lower than that before treatment(P<0.05),the score of upper eyelid and lower eyelid meibomian gland deficiency was significantly lower than that before treatment(P<0.05);1.4 In control group: After 2 weeks and 4 weeks of treatment,OSDI score in control group were significantly decreased compared with that before treatment(P<0.05),CFS was significantly lower than that before treatment(P<0.05);In addition,after 2 weeks treatment,SIT in control group was significantly increased compared with that before treatment(P<0.05);after 4weeks treatment,SPEED score of control group was significantly decreased compared with that before treatment(P<0.05),palpebral margin score was significantly decreased compared with before treatment(P<0.05),and meibomian gland deletion score of upper eyelid was significantly increased compared with before treatment(P<0.05).2.Comparison between groups before and after treatment2.1 Before treatment,there was no statistical difference in all indexes of patients between IPL group,Cs A group,combined group and control group(P>0.05).2.2 2 weeks after treatment2.2.1 Comparison between IPL group,Cs A group and combination group and control group: The OSDI score,SPEED score,FBUT and palpebral margin score of IPL group were better than those of the control group(P<0.05);the OSDI score,NITMH and FBUT of Cs A group were better than those of the control group(P<0.05),the OSDI score,SPEED score,NITMH,FBUT and palpebral margin score of the combined group were better than those of the control group(P<0.05);2.2.2 Comparison between combination group and IPL group: NITMH in combination group is better than that in IPL group(P<0.05);2.2.3 Comparison between the combined group and Cs A group: The eyelid margin score of the combined group is better than that of Cs A group(P<0.05);2.3 4 weeks after treatment2.3.1 Comparison between IPL group,Cs A group and combination group and control group: the OSDI score,FBUT and palpebral margin score in IPL group are better than those in control group(P<0.05);the SIT,NITMH and FBUT of Cs A group were better than those of the control group(P<0.05);the OSDI score,SPEED score,SIT,NITMH,FBUT,upper eyelid,lower eyelid meibomian gland loss score and palpebral margin score in combined group were better than those of the control group(P<0.05);2.3.2 Comparison between the combined group and IPL group: The OSDI score and NITMH in the combined group were better than those in the IPL group(P<0.05);2.2.3 Comparison between the combined group and Cs A group: The score of upper eyelid and lower eyelid meibomian gland loss in the combined group is better than that in Cs A group(P<0.05).Conclusion1.After 4 weeks of treatment with intense pulsed light combined with cyclosporine for dry eyes associated with moderate and severe meibomian gland dysfunction,the patient’s comfort,degree of corneal epithelial injury,tear secretion,tear film stability and meibomian gland structure recovery were improved compared with those before treatment;2.For dry eyes associated with moderate and severe meibomian gland dysfunction,after 4 weeks of treatment with intense pulsed light combined with cyclosporine,the patient’s comfort and tear secretion were better than those in the intense pulsed light treatment group,and the meibomian gland structure recovery was better than that in the cyclosporine treatment group.