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Título

EFFICACY OF LIPIFLOW IN THE TREATMENT OF DRY EYE DUE TO MEIBOMIAN GLAND DYSFUNCTION: A SYSTEMATIC REVIEW WITH META-ANALYSIS.

Introdução

Meibomian gland dysfunction (MGD) is the main cause of dry eye disease (DED) worldwide.Standard treatment is mainly based on lubricating eye drops and eyelid hygiene with warm compresses.LipiFlow thermal pulse system has been proposed as an alternative. This updated systematic review and meta-analysis aims to evaluate it in the treatment of meibomian gland dysfunction.

Métodos

We systematically searched EMBASE, MEDLINE, Cochrane, and Web of Science databases up to December 2022 for randomized clinical trials (RCTs) evaluating patients with meibomian gland dysfunction treated with LipiFlow. Main outcomes of interest were the meibomian gland scale (MGS), ocular surface disease scale (OSDI), Standard Patient Evaluation of Eye Dryness Questionnaire (SPEED) and Tear Break-up time (TBUT). We performed leave-one-out sensitivity analyses and subgroup analyses involving patients undergoing cataract surgery and studies with non-treatment as the control group. Statistical analyses were performed using RStudio 4.3.1 software using a random-effects model. Heterogeneity was assessed with I2 statistics.

Resultados

We included 12 RCTs comprising 1,045 patients. Among them, 538 (51.5%) were treated with LipiFlow. An improvement was observed in the MGS at 3 months (MD 2.64 95%CI [0.48; 4.80]; p=0.04; I2=94%; Fig. 1), in the OSDI at 3 months (MD -6.62 95%CI [-12.78; -0.45]; p=0.02; I2=59%; Fig. 2), as well as in the TBUT at 1 month (SMD 0.21 95%CI [0.01; 0.40]; p=0.04; I2=19%; Fig 3). There was no statistical significance in the SPEED at 3 months (MD -2.24 95%CI [-4.85; 0.37] p=0.09; I2=83%; Fig. 4), TBUT at 3 months (MD 0.10 95% CI [-2.04; 2.33] p=0.93 I² = 79%), OSDI at 1 month (MD -2.86 95% CI [-7.24; 1.52] p=0.20 I² = 0%), and MGS at 1 month (MD 0.10 95%CI [-0.60; 0.40] p=0.69 I² = 55%).

Conclusões

The findings revealed statistically significant improvements in MGS, OSDI and TBUT at various time points, although some comparisons did not yield significant results. No statistical significance was observed for MGS and OSDI at 1 month, and for SPEED and TBUT at 3 months. These findings highlight the complex and variable nature of DED treatment responses and the importance of exploring subjective symptomatology with objective clinical measures to assess treatment efficacy. Overall, the current evidence suggests that LipiFlow can be a beneficial treatment option for DED, but ongoing research is crucial for refining treatment guidelines and optimizing patient outcomes.

Palavras Chave

Dry eye, Meibomian gland dysfunction, LipiFlow, OSDI, Meibomian Gland Score.

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