Visible Meibomian Gland Structure Increases After Vectored Thermal Pulsation Treatment in Dry Eye Disease Patients with Meibomian Gland Dysfunction

Arjan S Hura,1 Alice T Epitropoulos,2 Craig N Czyz,3,4 Eric D Rosenberg5 1Department of Ophthalmology University of Cincinnati, Cincinnati, OH, USA; 2Ophthalmic Surgeons & Consultants of Ohio Inc., Columbus, OH, USA; 3Ophthalmology, Section Oculofacial Plastic and Reconstructive Surgery, Ohio University/OhioHealth Doctors Hospital, Columbus, OH, USA; 4Ophthalmology, Oral and Maxillofacial Surgery, Grant Medical Center, Columbus, OH, USA; 5New York Presbyterian Hospital – Cornell Campus, New York, NY, USACorrespondence: Arjan S HuraUniversity of Cincinnati, Department of Ophthalmology, 231 Albert Sabin Way, 5th Floor, Cincinnati, OH 45267, USATel +1 513 558-5151Email huraas@mail.uc.eduPurpose: To assess the effect of vectored thermal pulsation treatment (VTP) on visible meibomian gland structure (VGS) in patients with meibomian gland dysfunction (MGD).Setting: Private group practice (A.T.E.).Design: Retrospective, single-blinded cohort study.Methods: Visible meibomian gland structure was evaluated at baseline and at 1-year in treatment (30 patients, 48 eyes) and control (13 patients, 22 eyes) groups. Meibography images were captured using dynamic meibomian imaging. Images were assessed using a novel morphometric analysis technique and analyzed for change in area of VGS (pixels). Additional outcomes measured include tear break up time, corneal staining, tear osmolarity, matrix metalloproteinase-9 (MMP-9), meibography grading, and meibomian gland evaluation.Results: As high as 69% of eyes in the treatment group showed an improvement in VGS versus 27% of eyes in the control group. As high as 31% of eyes in the treatment group showed a decline in VGS versus 73% of eyes in the control group. TBUT (p = 0.0001), corneal staining (p = 0.0063), and meibomian gland evaluation scores (p = 0.0038) all significantly improved after VTP treatment. However, SPEED scores, MMP-9, tear osmolarity, and meiboscale scores were not significantly improved 1-year post treatment.Conclusion: A morphometric analysis protocol of meibography provides clinically meaningful information that is undetectable with the standard semiquantitative method of grading meibomian gland structure. This is the first report indicating that gland structure may increase post-VTP relative to untreated controls, thus presenting significant implications regarding benefits and timing of VTP therapy. The described protocol is currently more appropriate for research than for clinical practice.Keywords: meibomian gland dysfunction, meibomian gland pixelar analysis, meibomian gland regeneration, vectored thermal pulsation