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Systemic antibiotic treatment for meibomian gland dysfunction-A systematic review and meta-analysis.Acta Ophthalmologica Feb 2024To review the efficacy and safety of oral doxycycline antibiotics versus macrolides in the treatment of meibomian gland dysfunction (MGD). (Meta-Analysis)
Meta-Analysis
PURPOSE
To review the efficacy and safety of oral doxycycline antibiotics versus macrolides in the treatment of meibomian gland dysfunction (MGD).
DESIGN
Systematic review and meta-analysis.
METHODS
We performed a systematic search of electronic databases for all peer-reviewed published studies which included clinical outcomes of oral antibiotic MGD treatment. Individual study data were extracted and evaluated in a weighted pooled analysis, including total sign and symptom scores, meibomian gland secretion score, tear break-up time (TBUT), fluorescein staining score and rate of complications.
RESULTS
Two thousand nine hundred and thirty-three studies were found, of which 54 were eligible for the systematic review, and six prospective studies were ultimately included for analysis, reporting on 563 cases from three countries. Age of affected patients ranged between 12 and 90 years. Overall, both treatment methods induced improvement in MGD signs and symptoms. In pooled analysis, macrolides were significantly superior in the total signs score (pooled standardized mean difference (SMD) -0.51, 95% confidence interval (CI): -0.99 to -0.03), meibomian gland secretion score (pooled SMD -0.25, 95%CI: [-0.48, -0.03]), TBUT (SMD -0.31, 95%CI: [-0.50, -0.13]) and fluorescein staining score (SMD -1.01, 95%CI: [-1.72, -0.29]). Moreover, while no severe complications were reported for both treatments, the macrolide group exhibited significantly less adverse events (pooled odds ratio 0.24 with a 95% CI of 0.16 to 0.34).
CONCLUSIONS
Both macrolides and tetracyclines are effective treatments for MGD. In this study, macrolides exhibited better efficacy and safety profile compared to tetracyclines.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Humans; Middle Aged; Young Adult; Anti-Bacterial Agents; Doxycycline; Dry Eye Syndromes; Eyelid Diseases; Fluoresceins; Macrolides; Meibomian Gland Dysfunction; Meibomian Glands; Prospective Studies; Tears
PubMed: 37139848
DOI: 10.1111/aos.15681 -
Asia-Pacific Journal of Ophthalmology...To determine the efficacy and safety of eyelid exfoliation treatment in dry eye disease (DED), blepharitis, and contact lens (CL) discomfort patients.
PURPOSE
To determine the efficacy and safety of eyelid exfoliation treatment in dry eye disease (DED), blepharitis, and contact lens (CL) discomfort patients.
METHODS
A systematic review that included only full-length randomized controlled studies, reporting the effects of eyelid exfoliation treatment in 2 databases, PubMed and Web of Science, was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The search period was between October 29, 2022 and December 6, 2022. The Cochrane risk of bias tool was used to analyze the quality of the studies selected.
RESULTS
A total of 7 studies were included in this systematic review. Eyelid exfoliation treatment influence on DED, blepharitis, and CL discomfort were analyzed in 6, 4, and 2 studies, respectively. Eyelid exfoliation treatment achieved a better improvement than control group interventions in all reported variables. The mean differences between both groups were as follows: Ocular Surface Disease Index score of -5.0 ± 0.9 points, tear breakup time of 0.43 ± 0.2 seconds, ocular surface staining of -1.4 ± 1.5 points, meibomian glands secretions of 1.2 ± 1.1 points, meibomian glands yielding liquid secretion of 0.6 ± 0.3 points, microorganism load of -3.2 ± 4.7 points, and Contact Lens Dry Eye Questionnaire-8 of -2.15 ± 0.1 points. Minimal discomfort (n = 13) and eyelid irritation (n = 2) were the main complications after an eyelid exfoliation treatment.
CONCLUSIONS
Eyelid exfoliation is a safe and effective treatment that should be indicated for DED, blepharitis, and CL discomfort.
Topics: Humans; Blepharitis; Meibomian Glands; Contact Lenses; Tears; Dry Eye Syndromes; Treatment Outcome
PubMed: 37042457
DOI: 10.1097/APO.0000000000000607 -
Canadian Journal of Ophthalmology.... Jun 2020To examine the effectiveness of intense pulsed light therapy (IPL) with meibomian gland expression (MGX) in treating meibomian gland dysfunction (MGD) and dry eye... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To examine the effectiveness of intense pulsed light therapy (IPL) with meibomian gland expression (MGX) in treating meibomian gland dysfunction (MGD) and dry eye symptoms.
DESIGN
Systematic review followed by a meta-analysis.
METHODS
This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Literature sources included MEDLINE, Embase, Cochrane Library, and meeting abstracts from Canadian Ophthalmological Society, The Association for Research in Vision and Ophthalmology, The American Academy of Ophthalmology, and The European Society for Cataract and Refractive Surgeons. Articles underwent 3 stages of screening before data extraction and meta-analysis.
RESULTS
After the initial search, 502 studies were found. Six articles were included for meta-analysis, and data were extracted after 3 stages of screening. Meta-analysis indicated significant increase in tear break-up time (TBUT) post-treatment in the <1-month follow-up (standardized mean difference [SMD] = 1.29; confidence interval [CI]: 1.10-1.48), up-to-6-month follow-up (SMD = 1.71; CI: 1.46-1.96), and >6-month follow-up (SMD = 2.04; CI: 1.68-2.40) groups. Moreover, meta-analysis suggested a nonsignificant improvement in Standardized Patient Evaluation of Eye Dryness (SPEED) scores after IPL with MGX at the <1-month follow-up (SMD = -1.35; CI: -1.70 to -1.01), up-to-6-month follow-up (SMD = -1.68; CI: -1.93 to -1.43), and >6-month follow-up (SMD = -2.04; CI: -2.40 to -1.68) groups. Meta-analysis also indicated a nonsignificant improvement in Schirmer's test values at the up-to-2-month follow-up (SMD = -0.27; CI: -0.66 to 0.12), up-to-6-month follow-up (SMD = 0.04; CI: -0.25 to 0.33), and >6-month follow-up (SMD = -0.01; CI: -0.31 to 0.28) groups.
CONCLUSIONS
The results suggested a significant increase in TBUT and a nonsignificant increase in SPEED and Schirmer's test values at all follow-up periods post-treatment. Ultimately, IPL with MGX appears to be a promising therapy for MGD.
Topics: Canada; Dry Eye Syndromes; Humans; Intense Pulsed Light Therapy; Meibomian Gland Dysfunction; Meibomian Glands
PubMed: 31941589
DOI: 10.1016/j.jcjo.2019.11.009 -
BMC Ophthalmology Jan 2024Dry eye is one of the most common ophthalmic conditions and can significantly impact quality of life. Meibomian gland dysfunction (MGD) is a major cause of evaporative... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Dry eye is one of the most common ophthalmic conditions and can significantly impact quality of life. Meibomian gland dysfunction (MGD) is a major cause of evaporative dry eye. We sought to conduct a systematic review and meta-analysis to estimate the prevalence and incidence of dry eye and MGD in Central and South America and to identify factors associated with disease burden.
METHODS
Data sources Ovid MEDLINE and Embase.
STUDY SELECTION
A search conducted on August 16, 2021, identified studies published between January 1, 2010, and August 16, 2021, with no restrictions regarding participant age or language of publication. Case reports, case series, case-control studies, and interventional studies were excluded.
DATA EXTRACTION AND SYNTHESIS
The review was based on a protocol registered on PROSPERO (CRD42021256934). Risk of bias was assessed in duplicate using a risk of bias tool designed for the purposes of descriptive epidemiological studies. Data were extracted by one investigator and verified by another for accuracy. Prevalence of dry eye and MGD were grouped based on study participant characteristics.
MAIN OUTCOMES AND MEASURES
Prevalence and incidence of dry eye and MGD in Central and South America. Summary estimates from meta-analysis with 95% confidence intervals (CI).
RESULTS
Fourteen studies (11,594 total participants) were included. The population prevalence of dry eye was 13% (95% CI, 12%-14%) in Brazil and 41% (95% CI, 39%-44%) in Mexico based on one study each. Meta-analyses suggested that dry eye prevalence was 70% among indoor workers (95% CI, 56%-80%; I, 82%; 3 studies), 71% among students (95% CI, 65%-77%; I, 92%; 3 studies), and 83% in general ophthalmology clinics (95% CI, 77%-88%; I, 88%; 2 studies). MGD prevalence ranged from 23% among indoor workers (95% CI, 16%-31%; 1 study) to 68% in general ophthalmology clinics (95% CI, 62%-72%; 1 study). No studies reported incidence of dry eye or MGD.
CONCLUSIONS
This systematic review and meta-analysis demonstrated considerable variation in the published prevalence of dry eye and MGD among the general population and subpopulations in Central and South America. Local and subpopulation estimates of dry eye disease burden may be valuable to assist needs assessments and implementation of measures to mitigate the condition.
Topics: Humans; Meibomian Gland Dysfunction; Prevalence; Quality of Life; Dry Eye Syndromes; Brazil; Meibomian Glands; Tears
PubMed: 38297204
DOI: 10.1186/s12886-023-03249-w -
Contact Lens & Anterior Eye : the... Apr 2024To compare the effectiveness of meibomian gland expression (MGX) combined with home-based therapy versus home-based therapy alone for the treatment of dry eye disease... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To compare the effectiveness of meibomian gland expression (MGX) combined with home-based therapy versus home-based therapy alone for the treatment of dry eye disease (DED) caused by meibomian gland dysfunction (MGD).
METHODS
A systematic review of randomized controlled studies (RCTs), reporting the effects of MGX combined with home-based therapy in 2 databases, PubMed and Web of Science, was performed according to the PRISMA statement. The search period was until August 20, 2023. According to the heterogeneity, a random or fixed effects model was performed in the meta-analysis. The standardized mean difference (SMD) was calculated to analyze dry eye symptoms (DES) score, tear film break-up time (TBUT), total corneal fluorescein staining (tCFS) and meibomian glands expressibility (MGE). All analyses were performed by RevMan Web, version 5.7. The Cochrane risk of bias tool was used to analyze the quality of the studies selected.
RESULTS
Two RCTs with a total of 99 patients were included. The studies reported that MGX combined with home-based therapy improves DES score, TBUT, tCFS and MGE compared to the home-based therapy. However, the meta-analysis indicated that MGX combined with home-based therapy only seems to be beneficial in reducing DES score (SMD -0.49; 95 % CI: -0.89 to -0.08; P = 0.02; I = 0 %). In addition, although TBUT, tCFS and MGE reported a slight trend in favor of MGX combined with home-based therapy, it was non-significant.
CONCLUSIONS
While MGX combined with home-based therapy seem to show some evidence of alleviating dry eye symptoms, there is insufficient evidence to conclude the effects of this treatment definitively particularly in improving dry eye signs caused by MGD, such as TBUT, tCFS and MGE. Therefore, further RCTs are needed to elucidate these results.
Topics: Humans; Meibomian Glands; Dry Eye Syndromes; Meibomian Gland Dysfunction; Phototherapy; Tears
PubMed: 38135593
DOI: 10.1016/j.clae.2023.102107 -
Eye & Contact Lens Oct 2022This study aimed to systematically evaluate the effect of intense pulsed light (IPL) therapy in patients harboring dry eye disease caused by meibomian gland dysfunction... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This study aimed to systematically evaluate the effect of intense pulsed light (IPL) therapy in patients harboring dry eye disease caused by meibomian gland dysfunction (MGD) based on qualified studies.
METHODS
The electronic databases, including PubMed, Cochrane, and Embase, were searched using keywords to identify available publications updated to November 2021. Relative risk or weighted mean difference combined with 95% confidence interval was used to synthesize the outcomes of included studies. The meta-analysis included 15 randomized controlled trials with 1,142 patients (2,284 eyes).
RESULTS
The results revealed that IPL could significantly decrease the ocular surface disease index (OSDI), standard patient evaluation of eye dryness (SPEED), artificial tear usage, tear film lipid layer, meibomian gland quality (MGQ), meibomian gland expression (MGX), and corneal fluorescein staining (CFS) while increase tear break-up time (TBUT) and noninvasive tear break-up time (NIBUT) compared with sham. Compared with MGX, IPL+MGX markedly decreased the SPEED, CFS, and tear meniscus height (TMH), but with increased TBUT. Compared with MGX, IPL showed significant effect in increasing the OSDI and TBUT, but decreasing the TMH and NIBUT. However, no significant differences were seen between IP+MGX and MGX in OSDI, MGQ, and MGX, nor between IPL and MGX in OSDI, SPEED, and TBUT.
CONCLUSION
We identified that the application of IPL alone or IPL combined with MGX elicited superior clinical effect for improving the eye function and symptoms in the treatment of MGD-related dry eye disease, which is considered available for wide clinical application.
Topics: Dry Eye Syndromes; Fluorescein; Humans; Intense Pulsed Light Therapy; Lipids; Lubricant Eye Drops; Meibomian Gland Dysfunction; Meibomian Glands; Tears
PubMed: 36044829
DOI: 10.1097/ICL.0000000000000934 -
Lasers in Medical Science Dec 2022To compare the effect of intense pulsed light (IPL) therapy and conventional treatments in meibomian gland dysfunction (MGD)-related dry eye disease (DED). A literature... (Meta-Analysis)
Meta-Analysis
To compare the effect of intense pulsed light (IPL) therapy and conventional treatments in meibomian gland dysfunction (MGD)-related dry eye disease (DED). A literature search was conducted in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP, and China Biology Medicine (CBM) up to January 2022. Randomized controlled trials (RCTs) were included. Mean differences (MDs) and their 95% confidence intervals (CIs) were calculated. A meta-analysis concerning changes in tear break-up time (BUT), changes in Ocular Surface Disease Index (OSDI) scores, changes in non-invasively measured tear break-up time (NIBUT), changes in corneal and conjunctival fluorescein staining (CFS) scores, and changes in Standard Patient Evaluation of Eye Dryness (SPEED) scores was carried out. The initial search identified a total of 1842 records in the databases, and 11 studies were included in the final analysis. Compared to conventional therapies, IPL therapy was associated with significantly reduced OSDI (MD, - 7.49; 95% CI, - 12.47 to - 2.5) and SPEED (MD, - 3.28; 95% CI, - 5.64 to - 0.93) scores, while BUT (MD, 1.94; 95% CI, 1.19 ~ 2.69) and NIBUT (MD, 2.55; 95% CI, 1.07 ~ 4.04) significantly increased. No significant difference was found in the change in CFS between the two groups. Both IPL treatment and traditional treatments are effective in the treatment of MGD-related DED. IPL application seems to be superior to traditional treatments.
Topics: Humans; Meibomian Gland Dysfunction; Meibomian Glands; Intense Pulsed Light Therapy; Dry Eye Syndromes; Fluorescein
PubMed: 36534219
DOI: 10.1007/s10103-022-03690-1 -
Frontiers in Physiology 2023This meta-analysis aims to determine whether ocular surface alterations are associated with disease severity in patients with obstructive sleep apnea-hypopnea syndrome...
This meta-analysis aims to determine whether ocular surface alterations are associated with disease severity in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). The protocol for this systematic review and meta-analysis was registered in PROSPERO. We conducted the search in six electronic databases (China National Knowledge Infrastructure, EMBASE, Cochrane Library, Web of Science, Wanfang, and PubMed) from since the construction of the databases to 30 December 2022. The standard mean difference (SMD) and correlation coefficients are reported as measures of the effect size in the presence of retrieved data. In addition, the random effects model or fixed effects model was used in a combined analysis. Stata 11.0 and R 3.6.1 were used for statistical analyses of the data. A total of 15 studies satisfied the inclusion criteria for this study. The prevalence of floppy eyelid syndrome (FES) and dry eye syndrome in patients with obstructive sleep apnea-hypopnea syndrome was 40 and 48%, respectively. In addition, the Schirmer 1 value and tear break-up time (TBUT) were remarkably reduced in patients with OSAHS when compared to that of the controls. The ocular surface disease index (OSDI) scores, Oxford corneal staining scores, and the rates of loss in the meibomian glands were elevated in patients with obstructive sleep apnea-hypopnea syndrome when compared to that of the controls, especially those with severe disease. Moreover, the Schirmer 1 value and tear break-up time exhibited a negative correlation with the apnea-hypopnea index (AHI), and the OSDI showed a positive association with the apnea-hypopnea index. Patients with OSAHS had a greater prevalence of FES than the healthy controls. They also showed lower Schirmer 1 value and tear break-up time but had a higher OSDI, Oxford corneal staining scores, and rates of loss in the meibomian glands than the healthy controls. (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=392527).
PubMed: 37215172
DOI: 10.3389/fphys.2023.1163947 -
Eye & Contact Lens Jan 2023To evaluate the improvement in symptoms and signs associated with intense pulse light (IPL) combined with low-level light therapy (LLLT) in the treatment of dry eye...
OBJECTIVES
To evaluate the improvement in symptoms and signs associated with intense pulse light (IPL) combined with low-level light therapy (LLLT) in the treatment of dry eye disease (DED).
METHODS
A systematic review of full-length original studies reporting the effects of IPL combined with LLLT for DED in two databases, PubMed and Scopus, was performed according to the PRISMA statement. The quality assessment tool for case series studies from the National Heart, Lung, and Blood Institute was used to analyze the quality of the studies selected.
RESULTS
The search provided a total of 393 articles, of which six were included. Significant decreases in the Ocular Surface Disease Index (OSDI) score, meibomian gland dysfunction (MGD) score, MGD grade, and meiboscore and increases in tear film stability, lipid layer thickness, and loss area of the meibomian gland have been reported. Concerning tear volume, tear meniscus height, and Schirmer test remained unchanged. In relation to tear osmolarity and corneal fluorescein staining, contradictory outcomes were found.
CONCLUSIONS
Intense pulse light combined with LLLT for the treatment of dry eye improves OSDI, tear film stability, and meibomian gland function; thus, this treatment may be recommended for DED patients due to MGD.
Topics: Humans; Low-Level Light Therapy; Meibomian Gland Dysfunction; Meibomian Glands; Dry Eye Syndromes; Tears
PubMed: 36455215
DOI: 10.1097/ICL.0000000000000958 -
Experimental and Therapeutic Medicine Aug 2020Meibomian gland dysfunction (MGD) is frequently encountered by eye care practitioners. It is characterised by obstruction of the Meibomian glands and/or alterations in...
Meibomian gland dysfunction (MGD) is frequently encountered by eye care practitioners. It is characterised by obstruction of the Meibomian glands and/or alterations in the consistency of glandular secretions. At present, no definitive treatment exists for this condition. The present meta-analysis was performed to assess the efficacy of intense pulsed light (IPL) therapy in the management of MGD. Databases including EMBASE, PubMed, Cochrane Central, MEDLINE and Google Scholar were systematically searched to identify clinical trials that assessed the efficacy of IPL in the treatment of MGD. Outcome measures were described as the standardized mean difference (SMD). The fixed- or random-effects model was selected for analysis based on the Cochrane I values representing heterogeneity. Publication bias was visually inspected using Begg's funnel plot. Data were synthesized from four randomized controlled trials (RCTs) comprising 122 subjects in the IPL group and 120 subjects in the control group. Pooled analysis indicated no statistically significant difference in the Standard Patient Evaluation of Eye Dryness (SPEED) scores between the two groups [SMD -0.16 (95% CI, -0.41 to 0.10)] but a significant increase in Non-Invasive Tear Break-Up Time (NIBUT) scores in the IPL group (SMD, 0.90; 95% CI, 0.40-1.40). To conclude, the results of the present study did not provide any conclusive evidence for the efficacy of IPL therapy in the management of MGD. The analysis indicated that IPL therapy may result in an improvement of objective NIBUT scores but has no effect on subjective SPEED scores. Given the limited number of studies performed to date, there is a requirement for more well-designed prospective RCTs with a larger sample size to provide further evidence on the efficacy of IPL therapy.
PubMed: 32765683
DOI: 10.3892/etm.2020.8838