Combined intense pulsed light therapy and low-level light therapy versus low-level light therapy alone in ocular surface disease

Abstract

Purpose The aim of this study was to compare the effectiveness of combined intense pulsed light (IPL) therapy and low-level light therapy (LLLT) (IPL/LLLT) to LLLT alone in patients suffering from ocular surface disease. Patients and methods This is a retrospective cohort study that included 80 patients with meibomian gland dysfunction (MGD) for whom combined IPL/LLLT or LLLT alone was performed between January 2022 and December 2022. The combined IPL/LLLT was used in 42 patients and the LLLT alone was used in 38 patients. The tear break-up time (TBUT), ocular surface disease index (OSDI) score, Schirmer’s test, inflammation grading, and meibomian gland (MG) expression and quality grading were assessed before and 5 weeks after the intervention. In addition, the time to symptom improvement was recorded. Results The mean age of the patients was 42.0±11.8 years with 53.8% being females. The mean MGD duration was 4.8±3.0 months. There were no statistically significant differences between the two study arms in the baseline TBUT, OSDI, Schirmer’s test, inflammation grading, and MG expression and quality grading ( P >0.05). Within each study group, the postintervention outcome measurements showed significant improvement compared to the baseline values ( P <0.05). Among the overall study sample, the mean TBUT improved from 5.9±1.8 to 9.3±2.4 s, the Schirmer’s test from 9.9±2.6 to 12.2±2.0 mm, and the mean OSDI score from 36±13.9 to 15.9±8.4 points. Moreover, the MG expression was normal in 61.25% after treatment compared to none at baseline. Significant improvement in the ocular surface inflammation was also noted with only 25% of included eyes having mild inflammation after completing the treatment compared to more than 60% at baseline (including 23.75% suffering a marked/severe inflammation). However, the magnitude of improvement showed no statistically significant differences between the two groups in TBUT ( P =0.065), Schirmer’s test ( P =0.299), or OSDI score ( P =0.88). The time until symptomatic resolution had an overall mean of 3.0±2.7 weeks. However, the patient satisfaction was concerning as 46.25% of the patients reported being very unsatisfied with the treatment received despite the clinical improvement. Conclusion While the patients in either group showed significant improvements after treatment in TBUT, ocular inflammation, Schirmer’s test, OSDI, and MG expression and quality, the magnitude of improvement was of no statistically significant difference between the two groups. Poor patient satisfaction was of concern in both study arms.