{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T06:01:32Z","timestamp":1771480892969,"version":"3.50.1"},"reference-count":40,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,7,31]],"date-time":"2021-07-31T00:00:00Z","timestamp":1627689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To evaluate ocular surface status and corneal higher\u2010order aberrations after a new ocular nebulization therapy combined with meibomian gland massage for the treatment of meibomian gland dysfunction (MGD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and methods<\/jats:title><jats:p>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\u2010corrected visual acuity (BCVA) testing; noncontact tonometry; fundoscopy; the Ocular Surface Disease Index (OSDI) questionnaire; tear film assessment encompassing tear meniscus height (TMH) and non\u2010invasive 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\u2009months after treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At 3\u2009months, the NB group showed significantly better improvement than the ED group in terms of TMH (0.23\u2009\u00b1\u20090.04 versus 0.19\u2009\u00b1\u20090.05, p\u2009=\u20090.002) and first breakup time (f\u2010BUT; 7.42\u2009\u00b1\u20092.49 versus 5.53\u2009\u00b1\u20092.12, p\u2009=\u20090.001). The average breakup time (Av\u2010BUT) of the NB group was significantly longer than that of the ED group at 1\u2009month (9.52\u2009\u00b1\u20092.70 versus 8.02\u2009\u00b1\u20092.33, p\u2009=\u20090.013) and 3\u2009months (5.53\u2009\u00b1\u20092.12 versus 8.35\u2009\u00b1\u20092.38, p\u2009=\u20090.018). Both groups achieved improvement in corneal fluorescein staining (CFS) and SIT results at 1 and 3\u2009months (p\u2009&lt;\u20090.05). At the 3\u2010month follow\u2010up, anterior corneal trefoil aberrations decreased significantly in the NB group (p\u2009=\u20090.008), and improvements in anterior corneal coma aberrations and posterior corneal higher\u2010order aberrations (HOAs) were observed in the ED group (p\u2009&lt;\u20090.05) over the 4\u2009mm pupil zone. Over a 6\u2009mm zone at 3\u2009months, anterior, posterior and total trefoil aberrations as well as total HOAs were significantly decreased in the NB group (p\u2009&lt;\u20090.05), while posterior HOAs and trefoil aberrations were found to be decreased in the ED group (p\u2009&lt;\u20090.05). For individual Zernike terms, anterior and total corneal Z(3, \u22123) showed decreases over the 4 and 6\u2009mm zones, while no improvement was detected in the NB group at 3\u2009months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.14961","type":"journal-article","created":{"date-parts":[[2021,7,31]],"date-time":"2021-07-31T20:11:48Z","timestamp":1627762308000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["An investigation into the effects of ocular nebulization combined with meibomian gland massage on ocular surface status and 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