Vectored thermal pulsation improves visible meibomian gland structure

Cynthia Matossian, MD, FACS

Our vigorous pursuit of meibomian gland disease treatments has always been somewhat limited by the general consensus that not much can be done to regenerate meibomian glands after they atrophy.

However, a new study shows that this may not be the case. In fact, this research implies that meibomian gland structure can increase following therapeutic intervention with thermal pulsation therapy. Although some earlier investigations offered a bit of hope that it may be possible to increase meibomian gland area and grow meibomian gland tissue, until now there has been no evidence that nonvisible or atrophied human meibomian glands can be reactivated as “regrowth” after vectored pulsation treatment.

This recent retrospective, single-masked cohort study compared dry eye disease markers and dynamic meibomian imaging between patients who had undergone vectored thermal pulsation (48 eyes of 30 patients) and those who had received a recommendation for thermal pulsation but elected not to proceed with the procedure (22 eyes of 13 patients). Before thermal pulsation, patients also received microblepharoexfoliation to clean the lid margin and remove debris around the lash base. After the treatment, patients were advised to continue their previous dry eye therapeutic regimen, which varied in combinations of artificial tears, warm compresses, punctal plugs, Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan), Xiidra (lifitegrast ophthalmic solution 5%, Novartis), omega-3 fatty acid supplements and lid scrubs.

Meibography images were assessed using a novel morphometric analysis technique and analyzed for change in area of visible meibomian gland structure. Additional outcomes measured included tear breakup time, corneal staining, tear osmolarity, matrix metalloproteinase-9, meibography grading and meibomian gland evaluation. Sixty-nine percent of treated eyes showed an improvement in visible meibomian gland structure at 1 year compared with baseline, whereas 73% of the control group eyes showed an overall decline in visible meibomian gland structure at 1 year compared with baseline.

If, as this study implies, we can therapeutically promote the regeneration of meibomian glands, the implications for patients and clinicians cannot be overstated, as it would require us to completely rethink our current management paradigm, impacting quality of life for countless patients. In this regard, future prospective investigations are urgently needed.

References:

• Arita R, et al. Br J Ophthalmol. 2013;doi:10.1136/bjophthalmol-2012-302668.
• Maskin SL, et al. Br J Ophthalmol. 2018;doi:10.1136/bjophthalmol-2016-310097.