Clinical Ophthalmology (Jul 2021)
Effectiveness and Safety of Combined Application of Three Modes of 2940-nm Erbium:YAG and 1064-nm Neodymium:YAG Lasers in Treatment of Meibomian Gland Dysfunction
Abstract
Ngamjit Kasetsuwan,1,2 Lita Uthaithammarat,1 Yonrawee Piyacomn,1 Usanee Reinprayoon,1,2 Chayanon Chatchavalvanich,3 Ratchathorn Panchaprateep3 1Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; 2Excellence Center of Cornea and Limbal Stem Cell Transplantation, Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 3Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandCorrespondence: Ngamjit KasetsuwanKing Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, ThailandTel +662-256-4142Email [email protected]: To study the effectiveness and safety of upper and lower eyelid treatment with combined application of three modes of 2940-nm erbium-doped yttrium aluminium garnet (Er:YAG) and 1064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) lasers in patients with baggy eyelids (formed by intraorbital fat herniation) who exhibited meibomian gland dysfunction (MGD).Patients and Methods: In this prospective cohort study, patients with baggy eyelid who exhibited MGD received combined laser treatment at baseline, as well as at the 4-, 8-, and 12-week follow-ups. The primary endpoint was meibum quality score at 16- and 24-week follow-ups; secondary endpoints were ocular surface index scores, tear film lipid layer thicknesses, tear break up times (TBUTs), Oxford scheme grades, and meibography grades at 16- and 24-week follow-ups. Adverse events, uncorrected visual acuities, best-corrected visual acuities, and intraocular pressures were also recorded.Results: Sixteen patients (four men and 12 women; mean age, 56.38 ± 8.64 years) were included. Meibum quality scores at the 16-week follow-up were significantly lower than scores at baseline (p=0.043) and at the 24-week follow-up (p=0.015). TBUT was significantly exacerbated at the 24-week follow-up, compared with baseline (p=0.001) and the 16-week follow-up (p=0.006). There were no significant changes in other parameters. All adverse events were mild and resolved without additional treatment.Conclusion: Combined application of three modes of 2940-nm Er:YAG and 1064-nm Nd:YAG lasers on upper and lower eyelids significantly improved meibum quality in patients with MGD; it ameliorated symptoms and signs of dry eye disease at 4 weeks after completion of laser treatment.Keywords: dry eye, erbium:YAG, meibomian gland dysfunction, meibum, neodymium:YAG
