Treatment Of Early Evaporative Dry Eye With Intense Pulsed Light After Cataract Surgery

Objective: To study the improvement of patients’ self-perception,meibomian gland morphology and function,and the changes of visual quality after intense pulsed light(IPL)treatment for patients with evaporation dry eyes(EDE)induced by meibomian gland dysfunction(MGD)1~3 months after phacoemulsification and Intraocular Lens(IOL)Implantation,and to explore the feasibility and effectiveness of IPL in treating early stage of EDE induced by MGD after cataract surgery.Methods:Thirty-nine patients(71 eyes)with evaporation dry eyes who were reexamined 1~3 months after cataract surgery in the Ophthalmology department of the Fourth Affiliated Hospital of China Medical University from October 2017 to August 2018 were selected as the research subjects.Collect the basic information of each subject and conduct the following inspections: Ocular Surface Disease Index(OSDI)questionnaire survey,Slit lamp microscope was used to evaluate and score the eyelid margin and meibomian gland orifice status.Measure tear break-up time(TBUT).Evaluating the position of MARX Line after corneal Fluorescein Staintest(FL).Schirmer I Test(SIT),OCULUS Keratograph eye surface comprehensive analyzer was used to record the tear meniscus height(TMH),non invasive break up time(NIBUT),conjunctival hyperemia score of each examinee.Infrared meibomian gland photography was used to observe the morphosis of meibomian gland,and to learn and score the level of meibomian gland loss(MGL).The OPD-Scan III was used to measure the Surface Regularity Index(SRI)and Surface Asymmetry Index(SAI).Objective Visual Quality Analysis System(OQAS TM II)was used to measure the Objective Scattering Index(OSI),MTF Cut Off,Strehl Ratio(SR),Predicted visual Acuity(PVA),and Mean OSI.Manual meibomian gland pressing was performed to evaluate the secretion status of meibomian gland,and score the secretion of meibomian gland.The meibomian gland was treated with IPL for 4 times,including upper and lower eyelid and periocular skin.Intense Pulsed Light(IPL)was applied to treat meibomian gland,including upper and lower eyelid and periocular skin,for once every 2 weeks,4 times in total.The above data were measured and collected again 2 weeks after the last treatment,and the changes of these datas before and after the treatment were compared.SPSS 24.0 statistical software was used for statistical analysis.Results: All patients felt their subjective symptoms relieved after treatment.There were various degrees of eyelid margin hypertrophy and meibomian gland orifice in the examinees,which improved after treatment,but the shape of the eyelid margin hypertrophy did not completely return to normal.The meibomian gland orifice score,meibomian gland secretion character score and meibomian gland secretion state score were all decreased,and the differences were statistically significant(P<0.01).TBUT is longer than before treatment,and the differences were statistically significant(P<0.01).OSDI score decreased,and the differences were statistically significant(P<0.01).The patients’ discomfort symptoms were relieved and their feelings were improved.But Marx line score and SIT had no change,the differences were not statistically significant(P>0.05).After treatment,there were no significant changes in tear meniscus height,the score and degree of meibomian gland loss,and the differences were not statistically significant(P>0.05).The first BUT and average BUT were significantly increased,and conjunctival congestion score decreased,the differences were statistically significant(P<0.01).There was no significant difference in SIR and SAI before and after treatment(P>0.05).OSI decreased significantly,MTF cut off,SR and PVA increased,and the differences were statistically significant(P<0.01).This showed that the patients’ intraocular scattering was reduced,the objective visual quality was improved,and the predicted visual acuity was obviously improved.Although Mean OSI decreased,the difference was not statistically significant(P > 0.05).No patient had adverse reactions during the treatment and withdrew from the experiment.Conclusion: IPL has a good effect on treating early stage of EDE after cataract phacoemulsification.It can significantly improve ocular discomfort symptoms of EDE patients induced by MGD after cataract surgery,prolong tear break-up time,improve visual quality,and improve the quality and quantity of meibomian gland secretion.The treatment process is safe,rapid,and has no side effects.It can be applied clinically.