Heating Wet Chamber Goggles (Blephasteam??) In Meibomian Gland Dysfunction Unresponsive To Warm Compress Treatment

摘要

Purpose: : To evaluate the safety and efficacy of wet chamber warming goggles (Blephasteam??) in patients with meibomian gland dysfunction (MGD) unresponsive to warm compress treatment. Methods: : We consecutively enrolled 15 adult patients with low-delivery, non-cicatricial, MGD unresponsive to warm compress treatment. We considered unresponsive the patients who showed no OSDI or BUT improvement after 3 weeks of treatment with warm compresses used twice a day during 10 minutes. The patients were instructed to use Blephasteam?? (Laboratoires Thea, Clermont-Ferrand, France) twice a day during 10 minutes, with a following lid massage. Outcome measures were assessed in the worst eye (lower BUT) at baseline and after 3 weeks, including OSDI score, BUT, corneal fluorescein staining, MGs expressibility, Schirmer test. In vivo laser scanning confocal microscopy (LSCM) was used to study MGs in the lower eyelid, quantifying the mean acinar units diameter (manually measured as the longest axis of the acinar unit), acinar units area (calculated automatically after manual demarcation of the boundary), density of MGs (manually marked inside each 400x400 ?μm frame and calculated automatically with the Cell Count software, Heidelberg Engineering GmbH, Dortmund, Germany), diameter of glandular orifices (manually marked as the longest axis of orifice); meibum secretion reflectivity; inhomogeneous appearance of interstice and wall of acinar units. Results: : After 3 weeks of treatment, mean OSDI score decreased from 37.7?±17.5 to 23.2?±12.4 and mean BUT decreased from 6.0?±2.5 to 8.4?±2.0 (P0.05, paired samples T-test). LSCM showed decrease of mean acinar diameter (from 105.3?±19.5 to 88.2?±23.6; P0.05) and area (from 8912?±2205 to 6876?±1418; P0.05). Conclusions: : Eyelid warming is the mainstay of the clinical treatment of MGD and its poor results may be often due to lack of compliance and standardization. Blephasteam?? wet chamber warming goggles are a promising alternative to classical warm compress treatment, potentially able to improve the weaknesses of the "warming approach".