Meibomian Gland Growth

[pythonidler]

Came across this paper written by Dr. ******, who has done probing for many patients on this forum.

http://bjo.bmj.com/content/early/201...ol-2016-310097

Apparently some patients that had probing done have had some of their meibomian glands increase in size after having the procedure.

From the paper:
"Post-MGP meibography of 34 lids (19 patients, ≥4.5 to ≤12months’ follow-up) showed 41.2% with MG growth"

This is very encouraging. I'd like to see more studies done on this as well as other MGD procedures such as Lipiflow and IPL.

[MGD1701]

Thanks for sharing such exciting news. Then I should do probing, even I dont have scar tissue??

[Omega3]

This is exciting. I really hope I can get the probing done soon.

[DryEyeNJ]

I wouldn't necessarily trust a review of a procedure by a person who invented it.

[pythonidler]

I wouldn't necessarily trust a review of a procedure by a person who invented it.

My big takeaway from this article is that it's possible for meibomian glands to regenerate after having atrophied for a long time. I wasn't aware that this was even possible until very recently. There are some pictures from this paper that clearly show growth for some patients.

[deep_dry_eye]

Did anyone else read the paper and look at the images in carefully? I am not convinced. It feels more like the camera positioning that makes an optical illusion that there is more area, but if you look very very very closely, it appears to have no tissue growth. Any other opinions here?

[Fifi87]

Steven L ****** studied patients with obstructive-MGD. On the first page, in the introduction we can read the following: "Symptoms develop from obstruction, causing elevated intraductal pressure,
leading to lid tenderness (LT) and inflammation with subsequent lipid tear deficiency and dry eye".

When you dont't suffer from lid tenderness or inflammation, then you don't have obstructive-MGD, thus this study is not about your problem.
If you have obstructive-MGD, then one method to deal with it is the following according to Steven L. Miskin: "using antibiotics and steroid along with lid hygiene using heat and lid margin cleansing
with optional pressure to the lid to express glands." or LipiFlow thermal pulsation.

LipiFlow according to the study is: "uses predetermined levels of external heat and pressure to try and force meibum through a duct and orifice obstructed by thickened meibum and intraluminal keratinised debris."

Meibom Gland Probing(MGP): "MGP inserts sterile stainless steel wire probes through the natural gland orifice to physically and directly unblock the orifice and ductal obstruction
from thickened meibum and other non-fibrotic sources of obstruction."

All quotations above is in the introduction. From all these I can assume that PROBING(MGP) is only effective or usable when you have obstruction in the duct and/or orifice.
According to the introduction probing can help you and if the obstructition is gone, then your Meibomian-glands can release their products (lipids) in your tear film and the production level can also increase while the funcionality of these glands improves and the number of expressible glands per lid increases.

When you have medicine induced Meibomian Glad Dysfunction and your ducts and orifices are okay, then this therapy is useless.

My opinion:
The therapy that Steven L. Miskin offers could be useful for people with obstructive-MGD, but I don't know about the risk factor. The procedure is invasive and I think it could induce heavy inflamamtion in the eyelids. The inflammation could be the cause once more for the gland obstruction. When it happens then what, repeating the procedure and endure the pain?

[MGD1701]

Some (top) doctors believe glands ''re-generation' is possible just with heat treatment
(LipiFlow, IPL, warm compress) + lid hygiene etc. One of my doctors in the University said the same. There are a few study/articles on this.

I think they mean once obstruction is removed, then glands can function again. (But seems only if these glands are ''still'' there/alive.

[deep_dry_eye]

Some (top) doctors believe glands glow is possible just with heat treatment
(LipiFlow, IPL, warm compress) + lid hygiene etc. One of my doctors in the University said the same. There are a few study/articles on this.

I think they mean once obstruction is removed, then glands can function again. (But seems only if these glands are ''still'' there/alive.)

While I generally agree with such statements. To the best of my knowledge, there are no published research literature to back up this claim. Please point me to such studies. The only papers that remotely claim tissue growth is ******'s paper and another IPL Chinese paper. I don't buy the Chinese paper as well, it was published in a questionable journal, and the quality of paper was really really poor (i.e., if you look at the p-values and the actual data, it doesnt make any sense). Here is the copy of the IPL paper: https://www.tandfonline.com/doi/full...3.2017.1406525

[MGD1701]

sorry, I meant gland ''re-generation'' NOT grow. Found this video,
publised May 27 2018

The Potential Increase in Visible Meibomian Gland Structure post-LipiFlow Treatment

Presented at the 8th Annual OhioHealth Research Symposium at Doctors Hospital in Founders 1/2 on Wednesday, May 23rd, 2018. Awarded Best Podium Presentation in a Surgical Specialty.

Authors: Arjan Hura, MD; Alice Epitropoulos, MD; Craig Czyz, DO, FACOS, FACS; Caroline Blackie, OD, PhD;
Tracy Davis (McClelland), COA, CRC

https://www.youtube.com/watch?v=za8Qo2sRdC0&t=19s

Unfortunaely this video quality is not so good. In one of Dr Toyos, 1st dr who applied IPL to treat MGD, recent videos, he also mentioned similiar things with IPL.

[deep_dry_eye]

sorry, I meant gland ''re-generation'' NOT grow. Found this video,
publised May 27 2018

The Potential Increase in Visible Meibomian Gland Structure post-LipiFlow Treatment

Presented at the 8th Annual OhioHealth Research Symposium at Doctors Hospital in Founders 1/2 on Wednesday, May 23rd, 2018. Awarded Best Podium Presentation in a Surgical Specialty.

Authors: Arjan Hura, MD; Alice Epitropoulos, MD; Craig Czyz, DO, FACOS, FACS; Caroline Blackie, OD, PhD;
Tracy Davis (McClelland), COA, CRC

https://www.youtube.com/watch?v=za8Qo2sRdC0&t=19s

Unfortunaely this video quality is not so good. In one of Dr Toyos, 1st dr who applied IPL to treat MGD, recent videos, he also mentioned similiar things with IPL.

Once again, while I don't doubt that LipiFlow may help remove blockages and inflammation and consequently improve the health/structure of the MGs, I don't think this YouTube video showed it. I'm not convinced based off the (low-quality) pictures in the slide. These guys were also sponsored by Johnson and Johnson (owner of LipiFlow), so its obvious that they need to spin out a positive image (pun intended).