Clinical Efficacy of Immediate Manual Meibomian Gland Expression After Thermal Pulsation (LipiFlow) for Obstructive Meibomian Gland Dysfunction: Comparison With Thermal Pulsation

Purpose: To evaluate the clinical efficacy and safety of immediate manual meibomian gland expression (MGX) after LipiFlow thermal pulsation (TearScience Inc, Morrisville, NC) for obstructive meibomian gland dysfunction and to compare the LipiFlow only and MGX after LipiFlow. Methods: Patients who underwent immediate manual MGX after LipiFlow or who received only LipiFlow treatment were included. Thirty eyes from 15 patients were enrolled in each group. All patients underwent 3 treatments at monthly intervals. All patients were followed up for 6 months after treatment. All patients were examined before and at 3 and 6 months after treatment. Examinations included the Ocular Surface Disease Index score, noninvasive tear film breakup time (NIBUT), lipid layer thickness (LLT), corneal and conjunctival staining, and tear meniscus height. Results: The Ocular Surface Disease Index scores improved in both groups during the follow-up periods (P= 0.001 andP= 0.001). In the LipiFlow-only group, the NIBUT and LLT significantly improved at 3 months (P< 0.001 andP= 0.006) but deteriorated at 6 months. In the MGX after LipiFlow group, the NIBUT and LLT improved at 3 months (P< 0.001 andP< 0.001), and this improvement was maintained at 6 months. The improvement of NIBUT at 3 months was greater in the MGX after LipiFlow group (3.24 +/- 1.16 to 9.25 +/- 1.36 s) than in the LipiFlow-only group (3.78 +/- 1.75 to 7.18 +/- 2.70 s), and the improvements of the LLT at 6 months were greater in the MGX after LipiFlow group (30.27 +/- 10.74 to 46.93 +/- 20.81 mu m) than in the LipiFlow-only group (34.70 +/- 10.79 to 38.73 +/- 14.70 mu m). Conclusions: Both LipiFlow only and MGX after LipiFlow were clinically effective for obstructive meibomian gland dysfunction. However, the efficacy and persistence of treatment were greater in patients who received MGX after LipiFlow.