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Efficacy and safety of a vectored thermal pulsation system (Lipiflow®) in the treatment of meibomian gland dysfunction: a systematic review and meta-analysis

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Abstract

Purpose

To investigate the efficacy and safety of a vectored thermal pulsation system (Lipiflow®) in the treatment of dry eye disease resulting from meibomian gland dysfunction (MGD).

Methods

We searched for randomized clinical trials (RCTs) in Embase, MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Web of Science, and ClinicalTrials.gov up to 4 January 2021. The subjective symptoms, objective tests of dry eye, meibomian gland function, and the incidence of adverse events were evaluated.

Results

Ten qualified RCTs incorporating 761 patients were analyzed. In the comparison of Lipiflow® treatment and lid hygiene, the subgroup with inconsistent units of randomization and analysis showed that the Lipiflow® treatment brought slight improvement in corneal fluorescein staining (mean difference (MD), − 0.42; 95% CI, − 0.75 to − 0.1), significant improvements in ocular surface disease index (OSDI) score (MD, − 7.4; 95% CI, − 11.06 to − 3.74), Standard Patient Evaluation of Eye Dryness (SPEED) score (MD, − 2.7; 95% CI, − 3.95 to − 1.45), meibomian glands yielding liquid secretion (MGYLS) (MD, 1.3; 95% CI, 0.78 to 1.82), and meibomian glands yielding secretion score (MGYSS) (MD, 4.09; 95% CI, 1.18 to 6.99). Meanwhile, significant improvements were detected in OSDI score, SPEED score, MGYLS, and MGYSS with patients who received Lipiflow® treatment compared with those who received nontreatment. The adverse events were comparable in the two control groups.

Conclusions

Lipiflow® treatment can improve the subjective and objective outcomes of MGD and does not increase the incidence of adverse events. The improper choice of units of analysis may be the leading cause of heterogeneity, which should be noted in the design of future ophthalmology research. Additional well-designed, large-scale RCTs are required to reach a firmer conclusion.

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Acknowledgements

The authors would like to acknowledge Mohan Ju, Jingjing Ma, and Huan Ying for their suggestions and revisions.

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Author notes

  1. Jindong Hu and Sixing Zhu contributed equally.

Authors and Affiliations

  1. Department of Integrative Medicine, Huashan Hospital North, Fudan University, Shanghai, 201907, China

    Jindong Hu

  2. Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Jindong Hu

  3. Institute of Science, Technology and Humanities of Shanghai, University of Traditional Chinese Medicine, Shanghai, 201203, China

    Sixing Zhu

  4. Department of Ophthalmology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Xuhui District, No.725 South Wanping Road, Xuhui District, Shanghai, 200032, China

    Xinquan Liu

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  1. Jindong Hu
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Contributions

Conceptualization: X.Q.L and J.D.H.; methodology: J.D.H.; software: J.D.H. and S.X.Z.; formal analysis: J.D.H. and S.X.Z.; investigation: J.D.H. and S.X.Z.; data curation: J.D.H. and S.X.Z.; writing—original draft preparation: J.D.H.; and writing—review and editing: X.Q.L. and J.D.H. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Xinquan Liu.

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Hu, J., Zhu, S. & Liu, X. Efficacy and safety of a vectored thermal pulsation system (Lipiflow®) in the treatment of meibomian gland dysfunction: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 260, 25–39 (2022). https://doi.org/10.1007/s00417-021-05363-1

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