Long-term efficacy of three treatments for severe MGD: a comparative study in Chinese patients

To evaluate and compare the long-term efficacy of manual meibomian gland expression (MGX), intense pulsed light combine with MGX (IPL+MGX), and LipiFlow in treating severe meibomian gland dysfunction (MGD) in Chinese patients.

In this prospective, randomized controlled trial, 95 patients with severe MGD were assigned to MGX (n = 33), IPL+MGX (n = 31), or LipiFlow (n = 31) groups. Clinical parameters-including Ocular Surface Disease Index (OSDI), non-invasive tear break-up time (NIBUT), lipid layer thickness (LLT), corneal fluorescein staining (CFS), Schirmer I test (SIT), meibomian gland expressibility (MGE), and meibography score-were evaluated at baseline, 1, 3, and 6 months after treatment.

All treatments significantly improved ocular symptoms and signs from baseline. IPL+MGX group achieved the most consistent and sustained improvement in OSDI and NIBUT throughout follow-up. LLT increased in all groups, peaking at 3 months and remaining elevated at 6 months, with no significant intergroup differences. CFS scores improved across all groups, with IPL+MGX and MGX showing faster early recovery. SIT remained unchanged, suggesting improvements stemmed primarily from lipid layer enhancement. Meibography scores showed minimal change.

MGX, IPL+MGX, and LipiFlow were all effective in improving signs and symptoms in severe MGD. IPL+MGX provide the most consistent long-term benefits in stabilizing tear film and alleviating symptoms.. These findings highlight the importance of individualized treatment strategies based on MGD severity and patient factors.