zithromax and Meibomian-Gland-Dysfunction

To systematically review studies of managing meibomian gland dysfunction (MGD) with azithromycin and pool clinical outcomes to show its effectiveness. Eligible studies were retrieved from five main electronic databases. Symptom score was the primary outcome, while clinical signs and objective measurements were secondary outcomes. Pooled rates for adverse events were also calculated. Improvements in each outcome after administering either oral azithromycin (OA) or topical azithromycin (TA) were pooled and measured by standard mean difference (SMD) to show the overall effectiveness. Then the effectiveness was sub-grouped by TA and OA. In addition, pooled outcomes after administering TA and oral doxycycline (OD) were compared with assess their effectiveness. Finally, 18 eligible studies were included. The overall pooled symptom scores were significantly reduced after administering both TA and OA [P < 0.0001; SMD = 1.54 (95% CI: 1.15-1.92)]. Similarly, the overall combined eyelid signs, plugging of the meibomian gland, meibum quality, and tear secretion were also distinctly improved. However, significant improvements for tear break-up time (TBUT) and corneal staining (CS) were achieved by TA (TBUT: P = 0.02; CS: P = 0.02) but not by OA (TBUT: P = 0.08; CS: P = 0.14). The pooled adverse event rates for TA and OA were 25% and 7%, respectively. Moreover, TA was comparable to OD to treat MGD regarding symptom score, TBUT and tear secretion. This study showed that MGD could be treated effectively with oral or topical azithromycin by improving symptoms, clinical signs, and stabilization of tear film. Topical azithromycin seemed to be superior over oral azithromycin or doxycycline in improving the quality of tear film in the short term.. 摘要: 已知• 睑板腺功能障碍 (Meibomian gland dysfunction, MGD) 是一种常见的眼表疾病, 以睑缘炎、霰粒肿和睑腺炎为特征, 为泪液蒸发过强性干眼综合征最常见的病因。• 大环内酯类抗生素已被证明治疗MGD有效, 但由于第一代大环内酯类抗生素严重副作用, 其临床应用受到限制• 阿奇霉素是第二代半合成大环内酯类抗生素, 具有半衰期长、眼内穿透性好、抗菌谱广等特点。本文探讨了• 本文对TA或OA治疗MGD的临床试验进行了系统回顾, 并通过汇集有关症状评分、临床体征及客观指标来总结结论。• 根据症状、体征及泪膜稳定性, 口服或外用阿奇霉素可有效治疗MGD, 其中眼局部应用阿奇霉素在改善泪膜质量方面优于口服阿奇霉素或多西环素。阿奇霉素治疗睑板腺功能障碍的系统回顾及荟萃分析摘要:本文查阅了阿奇霉素治疗睑板腺功能障碍 (Meibomian gland dysfunction, MGD) 的相关文献, 并将临床资料进行了系统综述以显示其临床的有效性。符合条件的研究入组来自于五个主要的电子数据库。主要临床结局为症状评价指标, 临床体征及客观指标为次要评价指标。另外, 也计算了不良事件的发生率。我们将口服阿奇霉素 (oral azithromycin, OA) 或眼局部滴用阿奇霉素 (topical azithromycin, TA)后个体的改善情况进行汇总, 并用标准化均数差值(standard mean difference, SMD)显示总体疗效。进一步根据TA和OA对疗效进行亚组分析。此外, 还比较了TA和口服多西环素 (oral doxycycline, OD) 的治疗结果, 以评估它们的疗效。最终纳入18项符合条件的研究。TA和OA的总体症状评分均显著降低 [P<0.0001; SMD=1.54 (95% CI: 1.15–1.92)] 。同样, 眼睑体征、睑板腺阻塞、睑脂质量和泪液分泌的总体评分也明显改善。然而, TA (TBUT: P=0.02; CS: P=0.02) 但不是OA (TBUT: P=0.08; CS: P=0.14)可以显著改善泪膜破裂时间 (tear break-up time, TBUT) 和角膜染色 (corneal staining, CS)。 荟萃分析后, TA和OA的不良事件发生率分别为25%和7%。另外, TA治疗MGD在症状评分、TBUT和泪液分泌方面与OD相当。研究表明, 口服或外用阿奇霉素治疗MGD可有效改善症状、临床体征及泪膜稳定性。短期外用阿奇霉素在改善泪膜质量方面优于口服阿奇霉素或多西环素。.

Topics: Azithromycin; Eyelid Diseases; Humans; Meibomian Gland Dysfunction; Meibomian Glands; Tears

To assess the efficacy of topical azithromycin drops versus oral doxycycline therapy in meibomian gland dysfunction.. The prospective randomised trial was conducted from December 2019 to June 2020 at the Qazi Hussain Ahmad Medical Complex, Nowshera, Pakistan, and comprised patients of either gender aged 26-42 years having long-standing posterior blepharitis / meibomian gland dysfunction. The subjects were randomised into two equal groups. Both the groups were advised to do warm compresses and lid massage three times a day for 5 min. each for 4 weeks. In addition, group A received azithromycin 1% drops 2 times/day for 1 week, followed by once a day for 3 weeks, while group B received oral doxycycline 100mg once a day for 4 weeks. Baseline, midstream at 2 weeks and post-intervention status, including subjective symptoms, were compared.. Of the 60 subjects enrolled, there were 30(50%) in each of the two groups; 32(53.3%) males and 28(46.4%) females. While all 30(100%) the participants in group A completed the trial without any adverse reaction to medication, 8(26.7%) in group B quit midstream owing to anorexia/nausea and gastrointestinal discomfort. Compared to baseline, reduction in both subjective and objective features of the disease in both groups were noted regardless of gender (p=0.08). No significant difference was evident in symptoms healing rate and improvement in foreign body sensation between the groups (p>0.05). Group A treatment improved eye redness, while group B proved better in respect of meibomian glands obstruction healing and corneal staining p<0.05).. Both topical azithromycin and oral doxycycline were effective and had their own edge as far as symptomatic improvement was concerned in the treatment of meibomian gland dysfunction.

Topics: Anti-Bacterial Agents; Azithromycin; Doxycycline; Female; Humans; Male; Meibomian Gland Dysfunction; Prospective Studies; Tears; Treatment Outcome

Topics: Anti-Bacterial Agents; Azithromycin; Doxycycline; Dry Eye Syndromes; Humans; Meibomian Gland Dysfunction; Meibomian Glands; Prospective Studies; Tears

To evaluate ocular surface status and corneal higher-order aberrations after a new ocular nebulization therapy combined with meibomian gland massage for the treatment of meibomian gland dysfunction (MGD).. This prospective randomized study involved 38 patients diagnosed with MGD. Subjects were classified into two groups: the nebulization and meibomian gland massage group (or NB group, 14 patients, 28 eyes) and the eye drop group (or ED group, 24 patients, 48 eyes). Azithromycin solution and esculin and digitalis glycoside eye drops were tested in the therapy. Best-corrected visual acuity (BCVA) testing; noncontact tonometry; fundoscopy; the Ocular Surface Disease Index (OSDI) questionnaire; tear film assessment encompassing tear meniscus height (TMH) and non-invasive keratograph breakup time (NIKBUT); corneal fluorescein staining; the Schirmer I test (SIT); and anterior, posterior and total corneal aberrations were evaluated at 1 and 3 months after treatment.. At 3 months, the NB group showed significantly better improvement than the ED group in terms of TMH (0.23 ± 0.04 versus 0.19 ± 0.05, p = 0.002) and first breakup time (f-BUT; 7.42 ± 2.49 versus 5.53 ± 2.12, p = 0.001). The average breakup time (Av-BUT) of the NB group was significantly longer than that of the ED group at 1 month (9.52 ± 2.70 versus 8.02 ± 2.33, p = 0.013) and 3 months (5.53 ± 2.12 versus 8.35 ± 2.38, p = 0.018). Both groups achieved improvement in corneal fluorescein staining (CFS) and SIT results at 1 and 3 months (p < 0.05). At the 3-month follow-up, anterior corneal trefoil aberrations decreased significantly in the NB group (p = 0.008), and improvements in anterior corneal coma aberrations and posterior corneal higher-order aberrations (HOAs) were observed in the ED group (p < 0.05) over the 4 mm pupil zone. Over a 6 mm zone at 3 months, anterior, posterior and total trefoil aberrations as well as total HOAs were significantly decreased in the NB group (p < 0.05), while posterior HOAs and trefoil aberrations were found to be decreased in the ED group (p < 0.05). For individual Zernike terms, anterior and total corneal Z(3, -3) showed decreases over the 4 and 6 mm zones, while no improvement was detected in the NB group at 3 months.. In terms of comfort and visual quality, nebulization therapy combined with meibomian gland massage to deliver azithromycin solution and esculin and digitalis glycoside eye drops appears to be more effective in treating clinical symptoms and signs of MGD than simply applying esculin and digitalis glycoside eye drops.

Topics: Azithromycin; Digitalis Glycosides; Dry Eye Syndromes; Esculin; Eyelid Diseases; Fluorescein; Humans; Massage; Meibomian Gland Dysfunction; Meibomian Glands; Ophthalmic Solutions; Prospective Studies; Tears

To examine the safety and efficacy of azithromycin eyedrops in Japanese individuals with meibomian gland dysfunction (MGD)-associated posterior blepharitis.. Individuals with MGD-associated posterior blepharitis who visited the Itoh Clinic, Saitama, Japan, were randomly assigned to receive azithromycin (1%) eyedrops (AZM group, 16 eyes of 16 patients) or preservative-free artificial tears (control group, 20 eyes of 20 patients) for 2 weeks. All subjects also applied a warming eyelid compress twice per day. Subjective symptoms (Standardized Patient Evaluation of Eye Dryness [SPEED] score), lipid layer thickness (LLT) and interferometric pattern of the tear film, plugging and vascularity of the lid margin, noninvasive break-up time of the tear film (NIBUT) and fluorescein-based break-up time of the tear film (TBUT), corneal-conjunctival fluorescein staining score, tear meniscus height, meibum grade, meiboscore, tear osmolarity, and Schirmer test value were determined before and after treatment. Side effects of treatment were also recorded.. In the AZM group, SPEED score, LLT, interferometric pattern, plugging and vascularity of the lid margin, NIBUT, TBUT, meibum grade, and tear osmolarity were significantly improved after treatment compared with baseline. The SPEED score, interferometric pattern, plugging, vascularity, meibum grade, and tear osmolarity were also significantly improved after treatment in the AZM group compared with the control group. Common side effects in the AZM group were transient eye irritation and blurred vision.. Azithromycin eyedrops improved eyelid inflammation, the quality and quantity of the lipid layer of the tear film, and tear film stability. Such eyedrops thus seem to be a safe and effective treatment for MGD-associated posterior blepharitis.

Topics: Azithromycin; Blepharitis; Eyelid Diseases; Humans; Meibomian Gland Dysfunction; Meibomian Glands; Ophthalmic Solutions; Tears

The efficacy of topical azithromycin (AZ) supplementation to systemic AZ has not been studied. This study evaluates the efficacy of topical AZ supplementation to systemic AZ, warm compresses, artificial tears, and lid scrubs for the treatment of meibomian gland dysfunction (MGD).. Eighty-five patients with stage 4 MGD were enrolled in the study. The patients enrolled into the study were divided into 2 groups. Group 1 comprised 55 patients who received preservative-free topical 1.5% AZ administered as a unit dose, and group 2 comprised 30 patients who did not receive topical AZ. Both groups were prescribed artificial tear eye drops and systemic AZ. Fluorescein tear film breakup time (TBUT), corneal staining, Ocular Surface Disease Index (OSDI) symptom scores, and meibum quality were evaluated at baseline and after 1 and 3 months.. The mean age of patients in group 1 was 48.3 ± 13.4 years (25 men and 30 women) and in group 2 was 50.7 ± 10.2 years (12 men and 18 women). After treatment at the first and third month, group 1 showed significant improvement in mean TBUT, mean corneal staining score, meibum quality, and mean OSDI scores compared with baseline (P < 0.05). In group 2, only the OSDI score and meibum quality improved significantly after treatment compared with baseline (P < 0.05).. These results demonstrate clinically and statistically greater improvement in MGD-associated signs and symptoms with the addition of topical AZ to the systemic treatment.

Topics: Anti-Bacterial Agents; Azithromycin; Biometry; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Male; Meibomian Gland Dysfunction; Meibomian Glands; Middle Aged; Ophthalmic Solutions; Prospective Studies

The treatment of moderate to severe meibomian gland dysfunction (MGD) with oral doxycycline requires a 6-week course of treatment and has frequent adverse effects (AEs), which may be associated with poor compliance.. To determine if the AEs of a 3-week course of oral azithromycin were equivalent to the AEs of a 6-week course of oral doxycycline.. This double-masked randomized clinical trial was conducted at a referral center in Thailand from September 2018 to May 2022. Participants with moderate to severe MGD judged unresponsive to conservative management were included.. Patients were randomized 1:1 to receive oral azithromycin (1 g once per week for 3 weeks) or oral doxycycline (200 mg daily for 6 weeks).. After initiating therapy, the study team assessed the total MGD score and Ocular Surface Disease Index (OSDI) score at the initial visit, at 6 weeks, and at 8 weeks, and assessed AEs at 6 weeks and 8 weeks. The prespecified equivalence margins for MGD score and OSDI score were set at ±2 and ±9, respectively.. A total of 137 eyes from 137 patients were randomized into groups, 68 eyes in the azithromycin group and 69 eyes in the doxycycline group (female, 66.4%; mean age, 62.0 [SD, 15.1] years). The adjusted mean difference of total MGD scores between groups at week 6 and week 8 were -0.33 (95% CI, -1.70 to 1.03; P for equivalence = .01) and 0.13 (95% CI, -1.59 to 1.84; P for equivalence = .02), respectively. The adjusted mean difference of OSDI between groups score at week 6 and week 8 was -1.20 (95% CI, -5.31 to 2.91; P for equivalence  < .001) and -1.59 (95% CI, -5.73 to 2.55; P for equivalence  < .001), respectively. In addition, patients treated with azithromycin had fewer gastrointestinal AEs (4.4% vs 15.9%; risk difference, 11.5%; 95% CI 1.6%-21.4%; P = .03).. These data support an equivalency of effects of azithromycin as compared with doxycycline for MGD score and OSDI score at both follow-up times. The study did not show more gastrointestinal AEs in the azithromycin group. The reduced dosing and potentially fewer gastrointestinal AEs associated with azithromycin support its use as an alternative to doxycycline for at least 6 weeks.. ThaiClinicalTrials.org Identifier: TCTR20180810001.

Topics: Anti-Bacterial Agents; Azithromycin; Doxycycline; Eye; Female; Humans; Meibomian Gland Dysfunction; Middle Aged

We evaluated the clinical features of postoperative anterior blepharitis following cataract surgery and the efficacy of topical azithromycin retrospectively. Thirty eyes of 30 patients with a clinical diagnosis of anterior blepharitis by 6 months postoperatively among those who underwent cataract surgery at our institution between November 2020 and June 2022 were included. The diagnosis of anterior blepharitis and the assessment of objective and subjective findings were based on the American Academy of Ophthalmology Blepharitis Preferred Practice Pattern

Topics: Anti-Bacterial Agents; Azithromycin; Blepharitis; Cataract; Eye Diseases; Foreign Bodies; Humans; Inflammation; Meibomian Gland Dysfunction; Ophthalmic Solutions; Retrospective Studies

Meibomian glands are essential in maintaining the integrity and health of the ocular surface. Meibomian gland dysfunction (MGD), mainly induced by ductal occlusion, is considered as the major cause of dry eye disease. In this study, a novel in vitro model was established for investigating the role of inflammation in the process of MGD.. Mouse tarsal plates were removed from eyelids after dissection and explants were cultured during various time ranging from 24 to 120 hours. Meibomian gland epithelial cells were further enzymatically digested and dissociated from tarsal plates before culturing. Both explants and cells were incubated in different media with or without serum or azithromycin (AZM). Furthermore, explants were treated with IL-1β or vehicle for 48 hours. Analyses for tissue viability, histology, biomarker expression, and lipid accumulation were performed with hematoxylin and eosin (H&E) staining, immunofluorescence staining, and Western blot.. Higher viability was preserved when explants were cultured on Matrigel with immediate addition of culture medium. The viability, morphology, biomarker expression, and function of meibomian glands were preserved in explants cultured for up to 72 hours. Lipid accumulation and peroxisome proliferator-activated receptor γ (PPARγ) expression increased in both explants and cells cultured in media containing serum or AZM. Treatment with IL-1β induced overexpression of Keratin (Krt) 1 in meibomian gland ducts.. Intervention with pro-inflammatory cytokine IL-1β induces hyperkeratinization in meibomian gland ducts in vitro. This novel organotypic culture model can be used for investigating the mechanism of MGD.

Topics: Analysis of Variance; Animals; Azithromycin; Blotting, Western; Cells, Cultured; Dry Eye Syndromes; Epithelial Cells; Female; Fluorescent Antibody Technique; Humans; In Vitro Techniques; Interleukin-1beta; Male; Meibomian Gland Dysfunction; Meibomian Glands; Mice; Mice, Inbred C57BL; PPAR gamma