| Summary: | Ngamjit Kasetsuwan,1,2 Lita Uthaithammarat,1 Yonrawee Piyacomn,1 Usanee Reinprayoon,1,2 Chayanon Chatchavalvanich,3 Ratchathorn Panchaprateep3 1Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; 2Excellence Center of Cornea and Limbal Stem Cell Transplantation, Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 3Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandCorrespondence: Ngamjit KasetsuwanKing Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, ThailandTel +662-256-4142Email Ngamjitk@gmail.comPurpose: To study the effectiveness and safety of upper and lower eyelid treatment with combined application of three modes of 2940-nm erbium-doped yttrium aluminium garnet (Er:YAG) and 1064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) lasers in patients with baggy eyelids (formed by intraorbital fat herniation) who exhibited meibomian gland dysfunction (MGD).Patients and Methods: In this prospective cohort study, patients with baggy eyelid who exhibited MGD received combined laser treatment at baseline, as well as at the 4-, 8-, and 12-week follow-ups. The primary endpoint was meibum quality score at 16- and 24-week follow-ups; secondary endpoints were ocular surface index scores, tear film lipid layer thicknesses, tear break up times (TBUTs), Oxford scheme grades, and meibography grades at 16- and 24-week follow-ups. Adverse events, uncorrected visual acuities, best-corrected visual acuities, and intraocular pressures were also recorded.Results: Sixteen patients (four men and 12 women; mean age, 56.38 ± 8.64 years) were included. Meibum quality scores at the 16-week follow-up were significantly lower than scores at baseline (p=0.043) and at the 24-week follow-up (p=0.015). TBUT was significantly exacerbated at the 24-week follow-up, compared with baseline (p=0.001) and the 16-week follow-up (p=0.006). There were no significant changes in other parameters. All adverse events were mild and resolved without additional treatment.Conclusion: Combined application of three modes of 2940-nm Er:YAG and 1064-nm Nd:YAG lasers on upper and lower eyelids significantly improved meibum quality in patients with MGD; it ameliorated symptoms and signs of dry eye disease at 4 weeks after completion of laser treatment.Keywords: dry eye, erbium:YAG, meibomian gland dysfunction, meibum, neodymium:YAG
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