Diamond Bur Microblepharoexfoliation, Intense Pulse Light and Meibomian Gland Expression for Evaporative Dry Eye
Condition: Dry Eye Disease
MeSH terms: Dry Eye Syndromes; Keratoconjunctivitis Sicca; Eye Diseases
Study type: Interventional

Summary: 
      The goal of this clinical trial is to assess the efficacy and safety of
      microblepharoeexfoliation (MBE), intense pulse light (IPL) and meibomian gland expression
      (MGX) combination in patients with meibomian gland dysfunction (MGD).

      The main question it aims to answer are:

        -  Does MBE-IPL-MGX treatment improve dry eye symptoms?

        -  Does MBE-IPL-MGX treatment improve dry eye signs?

      Participants were assigned to receive either three sessions of MBE-IPL-MGX treatment and
      home-based therapy (treatment group) or home-based therapy alone (control group).

      The investigators will compare both groups to see if MBE-IPL-MGX treatment is superior to
      home-based therapy.
    

Detailed description: 
      MBE is a novel in-office treatment that works by exfoliating the eyelid margins to remove the
      accumulated biofilm debris, epithelial keratinization and capped meibomian glands, resulting
      in better meibum outflow . Different studies have shown that MBE improves DED symptoms [1,2],
      demodex blepharitis [1-4] and meibomian gland function [2,3,5] In addition, meta-analyses
      recommend combining IPL with meibomian gland expression (MGX) compared to IPL or MGX alone
      [6-8]. However, the investigators have not found any studies evaluating the benefits of MBE
      combined with IPL and MGX.

      Consequently, the purpose of the current study is to evaluate whether MBE combined with IPL
      and MGX leads to an improvement of symptoms and signs in patients with DED due to MGD.
    

Intervention name(s): Microblepharoexfoliation; Intense pulse light; Meibomian gland expression; Home-based therapy
Intervention type(s): Procedure; Procedure; Procedure; Drug
Intervention description(s): MBE was performed using the yokefellow instrument (Youke Electronic Corporation, Guangzhou, China), which contains a handpiece with a 1.80 mm diameter medical-grade diamond bur. Patients underwent MBE on the upper and lower lid margin of both eyes at 500 rpm until complete removal of accumulated biofilm debris, epithelial keratinization or capped meibomian glands. MBE was carried out only in the first combined treatment session.; IPL treatment was carried out with Thermaeye Plus (MDS Medical Technologies SL, Barcelona, Spain). The procedure began by applying an ultrasound gel (Carmado SL, Alicante, Spain) to the patient's periocular areas and upper eyelids. In the periocular areas, 6 light pulses were applied; 4 light pulses on the skin below the lower eyelid (with handpiece placed horizontally in the first pass and vertically in the second pass) and 2 light pulses on the canthal area (with handpiece placed vertically in first and second pass). The parameters were as follows: (1) Filter: 650 nm; (2) fluence: 9 j/cm2; (3) pulses: 2; (4) duration: 3 ms; (5) Delay: 20 ms; and (6) Cooling: 70%. In the upper eyelids, 4 light pulses were applied; 2 light pulses in the first and second pass, respectively. The parameters were as follows: (1) Filter: 650 nm; (2) Fluence: 5 j/cm2; (3) pulses: 1; (4) duration: 3 ms and (5) Cooling: 70%.; Finally, the MGX was performed on both upper and lower eyelids of each eye with a Collins forceps (Medi Instrument Inc, New York, USA).; Home-based therapy was based on Therapearl eye mask warming compress (Bausch & Lomb, Madrid, Spain) twice a day and Eyestil synfo eyedrops (Sifi Iberica SL, Madrid, Spain) 4 times a day during the study
Other intervention name(s): MBE; IPL; MGX; HBT
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Microblepharoexfoliation; Intense pulse light; Meibomian gland expression; Meibomian gland dysfunction