Journal List > J Korean Ophthalmol Soc > v.57(5) > 1010580

Nam, Lim, Hyun, and Chung: Effects and Prognostic Factors of Automated Thermodynamic System Treatment for Meibomian Gland Dysfunction

Abstract

Purpose

To evaluate the effect and prognostic factors of automated thermodynamic treatment (thermal compression therapy device [KCL 1100®]) for Meibomian gland dysfunction (MGD).

Methods

Patients (48 eyes of 24 subjects) with MGD were recruited for a prospective clinical trial. Patients received 15-minute treatments twice a day using the KCL 1100®. Severity of dry eye symptoms were evaluated using the Standard Patient Evaluation for Eye Dryness (SPEED) and Ocular Surface Disease Index (OSDI), and severity of Meibomian gland function was evaluated using the Meibomian gland expressibility (MGE), Meibomian gland secretion (MGS) score and lipid layer thickness measured by LipiView®. To evaluate ocular surface, we measured tear break-up time (BUT) and fluorescein corneal staining score (Oxford scale). Data were presented for baseline and at 2 weeks and 1 month post-treatment.

Results

Dry eye symptom (SPEED, OSDI), Meibomian gland function (MGE, MGS), and ocular surface index (BUT, Oxford scale) of patients were significantly improved from baseline to 2 weeks (p < 0.05) and 1 month post-treatment (p < 0.05). In addition, patients with more severe dry eye symptom and Meibomian gland index at baseline examination achieved improvement in mild to moderate MGD (p < 0.05). Improvement of Meibomian gland function (MGE) was associated with improvement of ocular surface index (BUT, Oxford scale) (p < 0.05), but not with improvement of dry eye symptom (SPEED, OSDI) (p > 0.05). There were no significant adverse events during the treatment.

Conclusions

KCL 1100® automated thermodynamic treatment is an effective and safe treatment for MGD. Additionally, KCL 1100® is more effective in patients with moderate dry eye symptom and MGD.

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Figure 1.
Photographs of the thermal compression therapy device (KCL 1100®, Korea KCL, Bucheon, Korea). (A) The KCL 1100® is an automated thermodynamic treatment device system that generates heat and vibration, and massages the eyelid to treat Meibomian gland dysfunction (MGD). (B) Before the therapy, patients wore a moisturized cotton eye patch and then the device was used.
jkos-57-724f1.tif
Figure 2.
Improvement of dry eye symptom, ocular surface and Meibomian gland index. (A) The mean Standard Patient Evaluation of Eye Dryness (SPEED) and Ocular Surface Disease Index (OSDI) at baseline, 2 weeks, and 1 month. (B) The mean tear break-up time (BUT) and fluorescein corneal stain score (Oxford scale) measured at baseline, 2 weeks and 1 month. (C) The mean Meibomian gland expressibility (MGE) and Meibomian gland secretion (MGS) score for the 15 Meibomian test glands of the lower eyelid and lipid layer thickness (LLT) using LipiView® (TearScience®, Morrisville, NC, USA) measured at baseline, 2 weeks and 1 month. Dry eye symptom (SPEED, OSDI), ocular surface index (BUT, Oxford scale), and Meibomian gland index (MGE, MGS) were significantly improved after 1 month of treatment with KCL 1100® (Korea KCL, Bucheon, Korea). ‘Significant (p < 0.05).
jkos-57-724f2.tif
Figure 3.
Relationship between pre-treatment index and improvement during 1 month of thermodynamic treatment. (A, B) Scatter plots showed a negative correlation between initial value and change in dry eye symptom (Standard Patient Evaluation of Eye Dryness [SPEED], Ocular Surface Disease Index [OSDI]) and (C, D) Meibomian gland index (lipid layer thickness [LLT], Meibomian gland expressibility [MGE]). The patients with more severe dry eye symptom (SPEED, OSDI) and Meibomian gland index (LLT, MGE) at baseline examination achieved improvement with thermal compression therapy in mild to moderate Meibomian gland dysfunction (MGD).
jkos-57-724f3.tif
Figure 4.
Relationship between change of Meibomian gland opening and ocular surface index, and change in Meibomian gland opening and dry eye symptom. (A, B) Scatter plots showed a correlation between change in Meibomian gland opening (Meibomian gland expressibility [MGE]) and change in ocular surface index (tear breakup time (BUT), Oxford scale). (C, D) However, dry eye symptom (Standard Patient Evaluation of Eye Dryness [SPEED], Ocular Surface Disease Index [OSDI]) was not correlated with Meibomian gland opening (MGE). Meibomian gland opening (MGE) was associated with ocular surface index (BUT, Oxford scale), but not with dry eye symptom (SPEED, OSDI).
jkos-57-724f4.tif
Table 1.
Pretreatment demographics of patients who underwent automated thermodynamic therapy (48 eyes of 24 subjects)
Characteristics Value (range)
Age 61.9 ± 12.3 (22-79)
Sex (male:female) 7:17
SPEED 13.2 ± 6.08 (0-24)
OSDI 35.4 ± 25.4 (0.00-77.7)
MGE 3.08 ± 1.77 (0-10)
MGS 4.11 ± 3.05 (0-17)
LLT (nm) 73.0 ± 23.9 (29.00-100.00)
BUT (sec) 2.63 ± 1.30 (1.0-6.0)
Corneal staining score (Oxford scale) 0.75 ± 0.91 (0-3)

Values are presented as mean ± SD unless otherwise indicated. SPEED = standard patient evaluation for eye dryness; OSDI = ocular surface disease index; MGE = meibomian gland expressibility; MGS = meibomian gland secretion score; LLT = lipid layer thickness; BUT = tear breakup time.

Range: minimum value-maximum value.

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