ABSTRACT NUMBER - 15

THE EFFECTIVENESS OF TOPICAL ANTIBIOTICS VERSUS ANTIBIOTIC/STEROID COMBINATIONS TREATMENT FOR MEIBOMIAN GLAND DYSFUNCTION: A SYSTEMATIC REVIEW


Pauline Khoo, Kenneth Ooi, Stephanie Watson

Meeting:  2017 RANZCO


SESSION INFORMATION

Date:      -

Session Title: Cornea - Poster Abstracts

Session Time:      -

Purpose: To compare the effectiveness of topical antibiotic to topical antibiotic/steroid combinations in patients with blepharitis/meibomian gland dys- function (MGD).
Methods: We searched MEDLINE, EMBASE, Cina- hal, BIOSIS, Cochrane library and PubMed from 1997-2017. We included clinical trials where ble- pharitis/MGD were treated with topical antibiotic or antibiotic/steroid combinations. Search results were screened, trial quality assessed, and data extracted. The primary outcome was change in clinical signs and/or symptoms.
Results: We included 11 randomised controlled tri- als and 3 clinical trials that enrolled a total of 2763 eyes from 2645 adult patients. Eight studies were identifted with topical antibiotic/steroid combina- tions and six for topical antibiotic. Seven studies had high risk of performance bias, of those, 5 had detection bias. Due to the heterogeneity of included studies (measured outcomes, follow-up periods, comparisons, participant condition) meta-analysis was limited. From available data, combination treat- ment studies demonstrated that a short course (4-14 days) of antibiotic/corticosteroid therapy signift- cantly improved ocular signs and symptoms. How- ever, Dexamethasone 0.1%/Tobramycin 0.3% (DE/T) showed higher risk of increased intraocular pressure compared to Loteprednol 0.5%/Tobramy- cin 0.3% (LE/T). For antibiotic treatment alone, Azi- thromycin (AZM) was studied in 5 trials, at a range of doses (1.0-1.5%), frequency (BID-QD) and dura- tion (3-30 days). AZM signiftcantly improved clini- cal signs and symptoms, and showed that longer duration at lower-frequency maintained improve- ments compared to shorter duration at higher-fre- quency. Two studies compared AZM to DM/T, fast in?ammation relief was found with DM/T. Conclusion: Clinical improvement was found with topical antibiotics and antibiotic/steroid combina- tions, however AZM and LE/T had good clinical outcomes with a higher degree of safety. Future studies should standardise methods and endpoints.