Effects of Intense Pulsed Light on Presumed Neuropathic Pain Associated with Meibomian Gland Dysfunction: A Before-After Study.

IF 1.9 4区 医学 Q2 OPHTHALMOLOGY
Gautier Hoarau, Anne-Laurence Best, Sourour Zina-Meziou, Maya Benali-Abdallah, Mhamed Loukil, Magalie Bouvet, Emmanuel Barreau, Antoine Rousseau, Marc Labetoulle
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Abstract

Purpose: Meibomian gland dysfunction (MGD) may cause chronic ocular surface pain (COSP) with a neuropathic component that can significantly impact quality of life and be poorly responsive to conventional treatments of MGD. Intense pulsed light (IPL) is an emerging treatment already acknowledged as improving refractory MGD, potentially modulating inflammatory mediators on the ocular surface. This study aimed to assess the impact of IPL on COSP associated with unresponsive MGD. Methods: A monocentric prospective study has been conducted from 2021 to 2023 on patients presenting with moderate MGD and COSP non-responsive to conventional treatments of MGD. Neuropathic pain components were suspected when severe discomfort (OSDI score above 33/100) was observed despite moderate objective signs. Three sessions of IPL were performed at a two-week interval. The primary outcome was change in OSDI at day 60. Secondary outcomes included OSDI modification at D120, DEQ-5, and Pentascore results at D60/D120, together with changes in clinical [Schirmer I, Fluorescein Break-up time (BUT), fluorescein staining, and MGD classification] and paraclinical tests [noninvasive BUT, tear meniscus height (TMH), and meibography]. Results: A significant improvement of COSP (p < 0.05 for changes in OSDI and Pentascore results) was observed 2 and 4 months after the last IPL session, together with an improvement in tear film stability, corneal epitheliopathy, meibomian gland obstruction, and TMH. Conclusion: The results of this study suggest the beneficial effect of IPL on neuropathic component of COSP associated with MGD. The underlying mechanisms involved in that improvement, presumably related to downgrading of inflammatory effectors, remain however to be explored.

强脉冲光对与睑板腺功能障碍有关的假定神经性疼痛的影响:前后对比研究
目的:睑板腺功能障碍(MGD)可能会引起慢性眼表疼痛(COSP),并伴有神经病理性成分,严重影响生活质量,而且对 MGD 的传统治疗方法反应不佳。强脉冲光(IPL)是一种新兴的治疗方法,已被公认可改善难治性麦粒肿,并有可能调节眼表面的炎症介质。本研究旨在评估 IPL 对与无反应性 MGD 相关的 COSP 的影响。研究方法从 2021 年到 2023 年,对中度 MGD 和对 MGD 常规治疗无反应的 COSP 患者进行了单中心前瞻性研究。尽管客观体征一般,但如果观察到严重不适(OSDI 评分超过 33/100),则怀疑有神经性疼痛成分。每隔两周进行三次 IPL 治疗。主要结果是第 60 天 OSDI 的变化。次要结果包括OSDI在第120天时的变化、DEQ-5和Pentascore在第60天/第120天时的结果,以及临床[Schirmer I、荧光素破裂时间(BUT)、荧光素染色和MGD分类]和辅助临床测试[无创BUT、泪液半月板高度(TMH)和眼睑膜造影]的变化。结果:在最后一次 IPL 治疗后 2 个月和 4 个月,COSP 有了明显改善(OSDI 和 Pentascore 结果的变化 p < 0.05),泪膜稳定性、角膜上皮病变、睑板腺阻塞和 TMH 也有改善。结论本研究结果表明,IPL 对与 MGD 相关的 COSP 神经病理性成分具有有益的影响。然而,这种改善所涉及的潜在机制(可能与炎症效应因子的降级有关)仍有待探索。
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来源期刊
CiteScore
4.60
自引率
4.30%
发文量
72
审稿时长
1 months
期刊介绍: Journal of Ocular Pharmacology and Therapeutics is the only peer-reviewed journal that combines the fields of ophthalmology and pharmacology to enable optimal treatment and prevention of ocular diseases and disorders. The Journal delivers the latest discoveries in the pharmacokinetics and pharmacodynamics of therapeutics for the treatment of ophthalmic disorders. Journal of Ocular Pharmacology and Therapeutics coverage includes: Glaucoma Cataracts Retinal degeneration Ocular infection, trauma, and toxicology Ocular drug delivery and biotransformation Ocular pharmacotherapy/clinical trials Ocular inflammatory and immune disorders Gene and cell-based therapies Ocular metabolic disorders Ocular ischemia and blood flow Proliferative disorders of the eye Eyes on Drug Discovery - written by Gary D. Novack, PhD, featuring the latest updates on drug and device pipeline developments as well as policy/regulatory changes by the FDA.
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