| Objective and significance:Intense pulsed light(IPL)device are nonlaser,high-intensity light sources that use high-output flash lamps to produce a broad wavelength output of noncoherent light,usually ranging from 500-1200 nm.It has been applied to the treatment of patients with skin vascular problems since 1994.After more than 20 years of development,IPL has become a completely controllable and safety devices.Because its wide spectral range can cover the absorption of the three main chromophores in our skin hemoglobin,melanin,and water can be simultaneously targeted,leading to themotropy and resultant destruction of target tissues such as pigment and vascular lesions.In recent years,it is mainly used in cosmetic skin treatment.It is widely recognized by doctors and patients for its non-invasive treatment.The recent studies have shown that periorbital therapy with IPL has a definite effect on dry eye disease(DED)cause by meibomian gland dysfunction(MGD).The exact mechanism is unclear.Periorbital skin is the thinnest part of the whole body.This study carried out a series of three-part clinical application studies of IPL periorbital treatment,aiming to optimize the parameters and the IPL treatment of periorbital,and further expand new indications.The advantages of IPL therapy,a simple,safe and non-invasive treatment,can be enhanced.Part One The study on parameter optimization of intense pulsed light for periorbital therapy in Chinese patients Intense Pulsed Light Treatment for Meibomian Gland Dysfunction in Skin Types?/?ObjectiveSeveral cases of dry eye disease(DED)caused by meibomian gland dysfunction(MGD),particularly the moderate to severe ones,are considered intractable by traditional therapy.Intense pulsed light(IPL)therapy has emerged as a new choice for management of MGD in recent years.But the study about this focused on the white people.The skin of Chinese patients mainly belongs to Fitzpatrick skin types?/?.Given that use of lasers and optical treatments is typically challenging inpatients with darker skin types.Because the melanin in skin can absorb the light selectively.IPL treatment for MGD is administered in the periorbital area with the thinnest skin areas of the body skin which has an inherent risk of skin side effects.What's more,the incidence of DED in China is higher than the developed countries.We try to find the optimal treatment parameters for skin types ?-?.MethodsForty MGD patients(skin types ?-?)were randomly administered IPL treatment with two types of parameters in the left and the right eye.The two groups had the same pulse setting with 2 pulses,3.0 ms pulse duration time and 30 ms pulse delay.But different energe settings(short wave and high energy:560 nm,16 mJ/cm2;long wave and low energy 590 nm,14 mJ/cm2)All of the patients accept 3 times treatments.The intervals of first two therapies were two weeks,and the intervals of the last two therapies were one month.Meanwhile,the original artificial tear drops for the treatment of dry eyes(Hycosan,sodium hyaluronate eye drops,Germany)were used as usual.Assessment indices,including BUT(RT-7000,Tomey,Japan),OSDI(Ocular surface disease index),patient satisfaction,and adverse events,were recorded once before each IPL treatment was administered.ResultsBoth of the parameter settings of IPL treatment could gradually and effectively raise the tear breakup time(BUT)and ocular surface disease index(OSDI)score.There was no significant difference in efficacy(including BUT,OSDI and patient satisfaction)between the two groups.The short wave and higher energy group did not achieve better therapeutic effects than the long wave and lower energy group,but it did induce an additional incidence of skin discomfort(erythema,tingling and burning sensation were higher).Elderly patients have more basic pigment problems such as senile plaques,sunspots and inflammatory pigmentation than the younger group,which increases the risk of pigmentation and the occurrence of skin discomfort.Although pigmentation will eventually fade,it increases anxiety and discomfort.Thus,the parameters for the old patients need reasonable parameters.What's more,the younger patients showed better improvement in BUT(F=19.54,p<0.01)and OSDI(F=9.93,p<0.01)compared with older patients.ConclusionIPL treatment is safe and effective in MGD patients with skin types ?/?.Our study has a good parameter setting recommendation(Lumenis One.2 pulses,3.0 ms pulse duration time and 30 ms pulse delay,590 nm,1mJ/cm2).Part Two The clinical study of Optimized periorbital IPL treatment Preliminary assessment of intense pulsed light treatment on the upper eyelids for meibomian gland dysfunctionObjectiveTo conduct a preliminary assessment of the intense pulsed light(IPL)treatment of the upper eyelid.BackgroundIn recent years,IPL therapy has been shown an effective therapy for dry eye disease caused by meibomian gland dysfunction(MGD).The normal treatment region includes the skin below the lower eyelids and both temporal parts,but not the upper eyelid.While we found that some patients with dry eye still had symptoms and signs in their upper eyelid after the normal IPL treatment.Considering that there are more and denser and longer meibomian gland in the upper eyelid than lower eyelid.If the upper eyelid area were included into the treatment range of IPL,the overall effect may be better.In this study,we attempted to evaluate the effectiveness of it preliminarily.MethodsThirty patients with mid-to-severe dry eye disease caused by meibomian gland dysfunctionwere selected and randomly divided into two groups.Fifteen controls in group A received normal IPL treatment.Fifteen patients in Group B underwent additional IPL treatment on the upper eyelid.The change in noninvasive tear breakup time(BUT),Ocular Surface Disease Index questionnaire(OSDI),patient satisfaction,and adverse events were measured and recorded before each treatment.ResultsThe dry eye symptoms of the patients in both groupswere improved.The patients in group B had better recovery than in group A:BUT(right eye:11.6±3.67 sec vs.7.73± 1.99 sec;left eye:12.73±4.19 sec vs.7.73±1.40 sec),OSDI(8.87±4.31 vs.14.93±3.47);patient satisfaction in group B remained good,but decreased in group A with prolonged treatment duration.No seriousskin and eyes complications were found in any patients.ConclusionsThis study showed the patients who received IPL treatment on the upper eyelid experienced improved symptoms of MGD.A further long-term study should be conducted to increase our understanding of the effect of expanded IPL treatment.Part Three The clinical study on the treatment of allergic conjunctivitis by intense pulse light periorbital treatmentIntense pulsed light treatment for Ocular itch Associated with allergic conjunctivitis:A retrospective study of 35 casesObjectiveTo conduct a preliminary assessment of intense pulsed light(IPL)treatment for ocular itch associated with allergic conjunctivitis.BackgroundCurrent control measures for allergic conjunctivitis(AC)rely primarily on drugs.Phototherapy has been shown effective for skin inflammation and pruritus,suggesting IPL treatment could be an effective treatment for eye itching in patients with dry eye disease(DED)complicated with AC.MethodsThirty-five patients with DED complicated withmid-to-severe AC were given three IPL treatments in the periorbital skin.Ascore of subjective symptoms,signs of AC and tear breakup time(BUT)before and after their each treatment were retrospectived and assessed.ResultsThe symptoms score was measured four times,including before(time 0)and up to 45 d(measurement 3)after treatment.The symptoms score significantly decreased with treatments(time 0 measurement was 30.97,measurement 1 15.03,measurement 3 10).The average signs score in both eyes was decreased after the first IPL treatment(OS 11.38 vs.7.97,OD 11.1 vs.8.1).There were no further improvments in the signs after two treatments.The BUT value in the right eyes increased from measurements 0 to 3(2.31 vs.4.66 vs.7.71 vs.7.74),there were no statistically significant differences between the 2nd and 3rd moment(7.71 vs.7.74).The BUT values in the left eyes at measurements 0 and 1(2.31 and 4.66)were significantly lower than the values of the 2nd and 3rd measurements(7.71 and 7.74).conclusionPatients with AC show improved symptoms and signs after IPL treatment.Phototherapy may have an effect of AC treatment.Summary:IPL treatment has advantages as simple operation,light pain and discomfort,noninvasive,short time et al.The patients can have normal life after the treatment.This series of clinical studies can provide a meaningful reference for its optimal application:1.Parameter control study based on secure treatment to find the iptimal treatment of equilibrium value.2.The local strengthening and expanding the scope of the treatment can make the treatment more effectively which aimed to shorten the treament course,and improvd the patient satisfaction.3.Further clinical study probably found the new indications of IPL.The result showed a new simple and effective way to relief the eye-itching caused by AC which are usually rely on drugs for short-term relief.In addition to effective relief of clinical symptoms of AC,it is more likely to reduce the sensitivity of patients' eyes and achieve the effect of desensitization treatment,so that patients can effectively control the degree of symptoms and reduce the recurrence rate.This series of studies also opens up new ideas for the application of IPL therapy in the future,and it is expected that this device can play its clinical effect more widely and effectively.hat this device can play its clinical effect more widely and effectively. |
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