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Background  To evaluate the effects of lid debris debridement and meibomian gland expression (MGX) on extracellular matrix metalloproteinase-9 (MMP-9) levels and clinical outcomes of moderate and severe MGD.    Methods  In this retrospective case series study, a total 48 eyes of 24 patients with moderate and severe MGD underwent one session of lid debris debridement using the BlephEx combined with MGX. We evaluated the tear film break-up time (TBUT), corneal and conjunctival fluorescein staining scores, Schirmer 1 test, biomicroscopic examination of lid margins and meibomian gland (MG), ocular surface disease index (OSDI) questionnaire score, and extracellular MMP-9 levels using a point-of-care MMP-9 immunoassay device before and 4 weeks after lid debris debridement and MGX. Linear mixed model and generalized estimating equations model were used to evaluate possible differences.    Results  There were significant improvements in the TBUT ( P  = 0.002), SICCA and Oxford staining scores (all  P  < 0.001), lid margin telangiectasia ( P  < 0.001 for upper and lower eyelids), lid thickness ( P  < 0.001 for upper and lower eyelids), MG orifice plugging ( P  < 0.001 for upper and lower eyelids), meibum color ( P  = 0.026 for upper eyelid,  P  < 0.001 for lower eyelid), meibum consistency ( P  < 0.001 for upper and lower eyelids), meibum grade ( P  < 0.001), MGD stage ( P  < 0.001), and OSDI score ( P  = 0.002). MMP-9 immunoassay positivity rate significantly decreased from 83.3 to 50.0% 4 weeks after treatment ( P  = 0.014).    Conclusions  In patients with moderate to severe MGD, lid debris debridement using the BlephEx combined with MGX improved clinical findings, subjective symptoms, meibomian gland function, along with ocular surface MMP-9 level. We hereby suggest lid debris debridement using BlephEx combined with MGX as an effective clinical strategy for treatment of moderate to severe MGD.

bmc ophthalmology

Effects of lid debris debridement combined with meibomian gland expression on the ocular surface MMP-9 levels and clinical outcomes in moderate and severe meibomian gland dysfunction