Comparative analysis of clinical and confocal outcomes in patients with meibomian gland dysfunction treated with warm compresses versus wet chamber warming goggles: a retrospective study.

摘要

Purpose: To retrospectively compare the efficacy of warm compress heat therapy to wet chamber warming goggles (Blephasteam??, Laboratoires Thea, Clermont-Ferrand, France) in treating mild to moderate meibomian gland disfunction (MGD). Methods: We reviewed medical records of our Ocular Surface Clinical and Research Center concerning the last 30 low-delivery, non-cicatricial, mild to moderate MGD patients treated with warm compresses (4 minutes twice daily), and the last 30 ones treated with Blephasteam??. We included in this study only patients with complete clinical data and in vivo laser scanning confocal microscopy (LSCM) examination of meibomian glands (MGs), both performed at the first visit and after 3-5 weeks of treatment. We excluded patients with ocular trauma or surgery in the previous 6 months, any systemic or ocular disease (other than dry eye) and any systemic or topical treatment (except artificial tears), ongoing or performed in the previous 3 months, with known effect on the ocular surface. We analyzed MGs confocal images in a masked manner, considering acinar units density, mean diameter, and reflectivity and orifices mean diameter. Statistical analysis was performed on the worst eye. Results: No significant differences of age, gender, clinical and LSCM data before treatment were found between the 2 groups. Both the groups showed decreased OSDI score (P0.01, paired samples t-test), increased BUT (P0.05), decreased acinar units diameter (P0.01) and reflectivity (P0.05, paired samples Wilcoxon test) after treatment. Comparing clinical and LSCM treatment-related changes between the warm compresses and the Blephasteam?? group, we found an higher decrease of MGs diameters in the second group (25.32?±6.14?μm vs 38.12?±8.05?μm; P0.05, independent samples t-test). Basing on the previously validated OSDI Minimal Clinically Important Difference, we found 4 and 1 not-responders to treatment in the 2 groups, respectively. Conclusions: LSCM provides important information on MGD-related glandular changes and their response to treatment. Eyelid warming is the mainstay of the treatment of low-delivery, non-cicatricial, mild to moderate MGD and its efficacy seems to be improved by devices able to increase standardization and compliance to therapy.