A retrospective study of the efficacy of intense pulsed light delivered by the Lacrystim® for meibomian gland dysfunction therapy

Marie-Caroline Trone, Thibaud Garcin, Edouard Ollier, Gilles Thuret, Philippe Gain, Marie-Caroline Trone, Thibaud Garcin, Edouard Ollier, Gilles Thuret, Philippe Gain

Abstract

Background: Meibomian gland dysfunction is the most common etiology of dry eye disease worldwide and intense pulsed light appears to be a promising treatment with encouraging results. Lacrystim® is a new IPL device (CE marking in 2019) and no studies have yet been published on it. We propose the first study on this device with an objective assessment of its efficacy and an extended follow-up over 6 months.

Methods: Patients presenting with a dry eye disease (DED) with stable mild to moderate MGD and having received Lacrystim® treatment between june 2019 and june 2020 were included. 3 IPL sessions were performed at D0, D15 and D45 with 4 shots per side at a fluence of 8 mJ/cm2. DED clinical evaluation was performed at D0, D15, D45, 3rd month and 6th month: Oxford scale and break up time, Schirmer test and Ocular Surface Disease Index (OSDI) questionnaire. Lacrydiag® imaging device carried out an objective examination of tear film: interferometry, meibography, tear meniscus height and non-invasive break up time (NIBUT). The primary endpoint was the evolution in NIBUT between the first visit D0 and 3rd month. Data collection was done retrospectively. Statistical analysis was done using a linear mixed-effects model and a non-parametric linear mixed-effects model (R software).

Results: Forthy five consecutive patients were included. NIBUT significantly increased between D0 and 3rd month: mean difference of 1.63 seconds, IC95% [0.51; 2.62], (p = 0.002) with a prolonged effect at 6th month. OSDI and OXFORD scores and interferometry were also significantly improved at 3rd month and 6th month. There was no significant change in BUT, Schirmer test and tear meniscus height. No adverse event was noted.

Conclusions: IPL delivered by Lacrystim® appears effective and safe to treat MGD although a randomized controlled trial is needed to validate its results.

Trial registration: This work was approved by a local ethics committee "Terre d'éthique" (institutional review board number: IRBN672019/CHUSTE) and registered on the clinicaltrial.gov website ( NCT04147962 , 01/11/2019).

Keywords: Dry eye disease; Intense pulsed light; Meibomian gland dysfunction; NIBUT.

Conflict of interest statement

Marie-Caroline TRONE, Gilles THURET and Philippe GAIN received fees from Quantel Medical to design the retrospective analysis chart. Quantel Medical played no role in data analysis, interpretation or writing of this work. Other authors have no competing interest.

All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Installation during a session of IPL treatment. The patient closed his/her eyes under the protective glasses during shooting. A is applied to the cheekbones. Four shots are made per side. (publication permission obtained from the patient)
Fig. 2
Fig. 2
Boxplot of non-invasive break-up-time (NIBUT) (A), ocular surface disease index (OSDI) (B) Oxford score (C) and interferometry (D) changes over time. Thick horizontal lines show the distribution median; boxes, the interquartile range (IQR); and individual points, the outliers between 1.5 and 3 times the IQR. Whiskers mark the highest and lowest non-outlying values. A Median NIBUT increased with time: 8.6 at day (D) 0, 8.7 at D45, 9.3 at 3rd month and 9.6 at 6th month. B OSDI score significantly improved over time with medians at 42.7 at D0, 34.2 at D45, 34.3 at 3rd month and 35.4 at 6th month. C Oxford score improved over time with medians at 2.0 at D0, 1.0 at D45, 1.0 at 3rd month and 1.0 at 6th month. D Interferometry significantly improved with a constant median over time at 30 at D0, D45, 3rd month and 6th month
Fig. 3
Fig. 3
Example of tests performed with LACRYDIAG® on a patient whose OSDI score improves from 45.8 at D0 to 27.08 at 3rd month. A NIBUT at D0 measured at 3.8 seconds. B NIBUT to 3rd month measured at 9.5 seconds. C Height of tear meniscus (unchanged by IPL treatment). D Interferometry (unchanged by IPL treatment). E Meibography of the right upper eyelid showing atrophy of the meibomius glands (unchanged by IPL treatment)

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