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Efficacy of Vectored Thermal Pulsation and Warm Compress Treatments in Meibomian Gland Dysfunction

A Meta-Analysis of Randomized Controlled Trials

Pang, Shin-Pin*; Chen, Yu-Tse*; Tam, Ka-Wai, MD, PhD†,‡,§,¶,‖; Lin, I-Chan, MD*,**; Loh, El-Wui, PhD†,‖

doi: 10.1097/ICO.0000000000001907
Clinical Science
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Purpose: Meibomian gland dysfunction is the main cause of dry eye disease (DED) and is traditionally managed using warm compress treatment (WCT). Vectored thermal pulsation treatment (VTPT) is a novel method for treating DED.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials that compared the efficacy of VTPT and WCT in treating DED. The primary outcome was the gland function. The secondary outcomes were the tear breakup time, Schirmer test, tear osmolarity, lipid layer thickness, Standard Patient Evaluation for Eye Dryness, and the improvement of subjective symptoms as assessed by using the Ocular Surface Disease Index. PubMed, Embase, Cochrane Library, and ClinicalTrials.gov registries were searched for studies published before July 2018.

Results: This study consisted of 4 trials with 385 patients. Significantly greater improvement was observed in meibomian gland function [mean difference (MD): 2.19 (95% confidence interval (CI), 0.95, 3.43)], tear breakup time [MD: 1.08 (95% CI, 0.06, 2.10)], and Standard Patient Evaluation for Eye Dryness [MD: −2.76 (95% CI, −4.22, −1.30)] at 2 to 4 weeks in the VTPT group than in the WCT group. A significantly greater decrease in Ocular Surface Disease Index was observed at 2 to 4 weeks [MD: −8.61 (95% CI, −13.62, −3.61)] and 3 months [MD: −6.92 (95% CI, −11.95, −1.89)] in the VTPT group than in the WCT group.

Conclusions: A single 12-minute VTPT was more efficacious than traditional WCT in treating DED either in objective or subjective measurements. We recommended choosing an appropriate treatment after shared decision-making.

*School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;

Center for Evidence-Based Health Care and Shared Decision Making Resource Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan;

Division of General Surgery, Department of Surgery, Shuang Ho Hospital, New Taipei City, Taiwan;

§Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;

Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan;

Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;

**Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; and

††Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.

Correspondence: El-Wui Loh, PhD, Center for Evidence-based Health Care, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City 23561, Taiwan (e-mail: lohelwui@tmu.edu.tw).

The authors have no funding or conflicts of interest to disclose.

S. -P. Pang and Y. -T. Chen contributed equally to this work.

Received October 07, 2018

Received in revised form January 03, 2019

Accepted January 09, 2019

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