Abstract
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。
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Yildiz E, Yenerel NM, Turan-Yardimci A, Erkan M, Gunes P. Comparison of the clinical efficacy of topical and systemic azithromycin treatment for posterior blepharitis. J Ocul Pharm Ther. 2018;34:365–72.
Nichols KK, Foulks GN, Bron AJ, Glasgow BJ, Dogru M, Tsubota K, et al. The international workshop on meibomian gland dysfunction: executive summary. Invest Ophthalmol Vis Sci. 2011;52:1922–9.
Huber-Spitzy V, Baumgartner I, Böhler-Sommeregger K, Grabner G. Blepharitis-a diagnostic and therapeutic challenge. A report on consecutive cases. Graefes Arch Clin Exp Ophthalmol. 1991;229:224–7.
Balci O, Gulkilik G. Assessment of efficacy of topical azithromycin 1.5 per cent ophthalmic solution for the treatment of meibomian gland dysfunction. Clin Exp Optom. 2018;101:18–22.
Henriquez AS, Korb DR. Meibomian glands and contact lens wear. Br J Ophthalmol. 1981;65:108–11.
Perry HD, Doshi-Carnevale S, Donnenfeld ED, Solomon R, Biser SA, Bloom AH. Efficacy of commercially available topical cyclosporine A 0.05% in the treatment of meibomian gland dysfunction. Cornea. 2006;25:171–5.
Rubin M, Rao SN. Efficacy of topical cyclosporin 0.05% in the treatment of posterior blepharitis. J Ocul Pharm Ther. 2006;22:47–53.
AlHity A, Lockington D. Oral azithromycin as the systemic treatment of choice in the treatment of meibomian gland disease. Clin Exp Ophthalmol. 2016;44:199–201.
Tabbara KF, al-Kharashi SA, al-Mansouri SM, al-Omar OM, Cooper H, el-Asrar AM, et al. Ocular levels of azithromycin. Arch Ophthalmol. 1998;116:1625–8.
Qiao J, Yan X. Emerging treatment options for meibomian gland dysfunction. Clin Ophthalmol. 2013;7:1797–803.
Borchman D, Yappert MC, Foulks GN. Changes in human meibum lipid with meibomian gland dysfunction using principal component analysis. Exp Eye Res. 2010;91:246–56.
Bakar O, Demircay Z, Toker E, Cakir S. Ocular signs, symptoms and tear function tests of papulopustular rosacea patients receiving azithromycin. J Eur Acad Dermatol Venereol. 2009;23:544–9.
Igami TZ, Holzchuh R, Osaki TH, Santo RM, Kara-Jose N, Hida RY. Oral azithromycin for treatment of posterior blepharitis. Cornea. 2011;30:1145–9.
Greene JB, Jeng BH, Fintelmann RE, Margolis TP. Oral azithromycin for the treatment of meibomitis. JAMA Ophthalmol. 2014;132:121–2.
Haque RM, Torkildsen GL, Brubaker K, Zink RC, Kowalski RP, Mah FS, et al. Multicenter open-label study evaluating the efficacy of azithromycin ophthalmic solution 1% on the signs and symptoms of subjects with blepharitis. Cornea. 2010;29:871–7.
Opitz DL, Tyler KF. Efficacy of azithromycin 1% ophthalmic solution for treatment of ocular surface disease from posterior blepharitis. Clin Exp Optom. 2011;94:200–6.
Doan S, Gabison E, Chiambaretta F, Touati M, Cochereau I. Efficacy of azithromycin 1.5% eye drops in childhood ocular rosacea with phlyctenular blepharokeratoconjunctivitis. J Ophthalmic Inflamm Infec. 2013;3:38.
Lazreg S. Role of Azithromycin in the treatment of children meibomian gland disease. Invest Ophthalmol Vis Sci. 2014;55:1501.
Mantelli F, Di Zazzo A, Sacchetti M, Dianzani C, Lambiase A, Bonini S. Topical azithromycin as a novel treatment for ocular rosacea. Ocul Immunol Inflamm. 2013;21:371–7.
Foulks GN, Borchman D, Yappert M, Kakar S. Topical azithromycin and oral doxycycline therapy of meibomian gland dysfunction: a comparative clinical and spectroscopic pilot study. Cornea. 2013;32:44–53.
Zandian M, Rahimian N, Soheilifar S. Comparison of therapeutic effects of topical azithromycin solution and systemic doxycycline on posterior blepharitis. Int J Ophthalmol. 2016;9:1016–9.
Kashkouli MB, Fazel AJ, Kiavash V, Nojomi M, Ghiasian L. Oral azithromycin versus doxycycline in meibomian gland dysfunction: a randomised double-masked open-label clinical trial. Br J Ophthalmol. 2015;99:199–204.
Heitz A, Arnaud S, Merklen C, Cribier B, Speeg-Schatz C, Bourcier T. Oral azithromycin versus doxycyclin for the treatment of moderate to severe meibomian gland dysfunction (MGD)—a randomized prospective non-inferiority study. Invest Ophthalmol Vis Sci. 2014;55:1481.
Luchs J. Efficacy of topical azithromycin ophthalmic solution 1% in the treatment of posterior blepharitis. Adv Ther. 2008;25:858–70.
Fadlallah A, Rami HE, Fahd D, Dunia I, Bejjani R, Chlela E, et al. Azithromycin 1.5% ophthalmic solution: efficacy and treatment modalities in chronic blepharitis. Arq Bras Oftalmol. 2012;75:178–82.
Doan S, Baudouin C, Labetoulle M, Bourcier T, Hoffart L, Pisella PJ, et al. Efficacy and safety of azithromycin 1.5% eye drops (Azyter®) in patients with moderate to severe chronic blepharitis. Invest Ophthalmol Vis Sci. 2014;55:47.
Aghai ZH, Kode A, Saslow JG, Nakhla T, Farhath S, Stahl GE, et al. Azithromycin suppresses activation of nuclear factor-kappa B and synthesis of pro-inflammatory cytokines in tracheal aspirate cells from premature infants. Pediatr Res. 2007;62:483–8.
Amar T, Caillaud T, Elena PP. Ocular pharmacokinetic study following single and multiple azithromycin administrations in pigmented rabbits. Curr Eye Res. 2008;33:149–58.
Sadrai Z, Hajrasouliha AR, Chauhan S, Saban DR, Dastjerdi MH, Dana R. Effects of topical azithromycin on corneal innate immune responses. Invest Ophthalmol Vis Sci. 2011;52:2525–31.
Liu Y, Kam WR, Ding J, Sullivan DA. Can tetracycline antibiotics duplicate the ability of azithromycin to stimulate human meibomian gland epithelial cell differentiation? Cornea. 2015;34:342–6.
Akpek EK, Vittitow J, Verhoeven RS, Brubaker K, Amar T, Powell KD, et al. Ocular surface distribution and pharmacokinetics of a novel ophthalmic 1% azithromycin formulation. J Ocul Pharm Ther. 2009;25:433–9.
Iovieno A, Lambiase A, Micera A, Stampachiacchiere B, Sgrulletta R, Bonini S. In vivo characterization of doxycycline effects on tear metalloproteinases in patients with chronic blepharitis. Eur J Ophthalmol. 2009;19:708–16.
Dougherty JM, Mcculley JP. Comparative bacteriology of chronic blepharitis. Br J Ophthalmol. 1984;68:524–8.
Mcculley JP, Dougherty JM. Bacterial aspects of chronic blepharitis. Trans Ophthalmol Soc UK. 1986;105:314–8.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Tao, T., Tao, L. Systematic review and meta-analysis of treating meibomian gland dysfunction with azithromycin. Eye 34, 1797–1808 (2020). https://doi.org/10.1038/s41433-020-0876-2
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41433-020-0876-2
This article is cited by
-
Catalpol inhibits Hedgehog signaling pathway to suppress proliferation and promote lipid accumulation in rat meibomian gland epithelial cells
Cytotechnology (2025)
-
Efficacy and safety of topical azithromycin therapy in patients with blepharitis and meibomian gland dysfunction
Japanese Journal of Ophthalmology (2024)
