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2014 Agenda and Abstracts | < Previous | Next >

2014 OMIG Abstract 22

Anti-Inflammatory Effect of Topical Combination Therapy in
Meibomian Gland Dysfunction (MGD)

Yureeda Qazi, MB, BS; Ahmad Kheirkhah, MD; Thomas Dohlman,
Reza Dana, MD, MSc, MPH; Pedram Hamrah, MD
Conea Service, Massachusetts Eye and Ear Infirmary, Boston, MA

Background: The role of inflammation in MGD is well-recognized. However, the synergistic benefit of a topical antibiotic with corticosteroids in the management of MGD-associated inflammation remains elusive.

Purpose: To quantifiably compare lid inflammation in patients with MGD using in vivo confocal microscopy (IVCM), comparing topical combination therapy containing steroid and antibiotic (LE/T: Loteprednol + Tobramycin) to steroid alone (LE: Loteprednol) or artificial tears (AT).

Methods: A randomized, double-masked, vehicle-controlled clinical trial was conducted with 54 subjects with MGD that received either AT, LE/T, or LE for 4 weeks with quantification of lid epithelial and stromal immune cell (EIC, SIC) densities on IVCM pre- and post-treatment.

Results: At baseline, all 3 groups had comparable lid inflammation (EIC, P = 0.47; SIC, P= 0.19). Lid immune cell densities, especially EIC, reduced in both treatment groups (P ≤ 0.04) LE/T and LE equally (P≥0.2), but not AT (P = 0.6). EIC decreased by 34% and 29% in the treatment groups LE and LE/T, whereas SIC was reduced by 32% and 14%, respectively. AT did not affect immune cell densities.

Conclusions: LE/T and LE are equally effective at reducing lid immune cell densities in MGD on IVCM. While both steroid-containing drugs reduced lid inflammation in MGD, the addition of an antibiotic to steroid did not render enhanced anti-inflammatory effects. A confounding factor possibly masking the anti-inflammatory effect of tobramycin could be its oculotoxic nature with chronic therapy. Furthermore, artificial tears had no demonstrable anti-inflammatory role in MGD. IVCM allowed quantifiable evaluation of lid inflammation in MGD.

AAO disclosure code: S (RD, PH); N for all other authors.
Funding support: Bausch and Lomb (to RD), NIH K08 EYE020575 (to PH), Falk Medical Research Trust (to PH and RD).

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