human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To compare the effectiveness of a single LipiFlow ( ® ) treatment with combined lid warming and massage in patients with meibomian gl and dysfunction ( MGD ) . METHODS In this prospect i ve , r and omized , crossover , observer-masked clinical trial , subjects were r and omized to receive either a single 12-min LipiFlow-LipiFlow Thermal Pulsation ( LTP ) system treatment or to perform combined twice-daily lid warming and massage for 3 months . All subjects were examined before , and 1 and 3 months after initiation of treatments . Investigated parameters included subjective symptoms , lipid layer thickness , meibomian gl and assessment , tear break-up time , tear osmolarity , corneal and conjunctival staining , Schirmer test values , and tear meniscus height . RESULTS A total of 31 subjects completed the 3-month follow-up . At 1 and 3 months , patients in the LipiFlow treatment group had a significant reduction in Ocular Surface Disease Index ( OSDI ) scores compared with those in the lid-margin hygiene group . Both treatments produced a significant improvement in expressible meibomian gl and s compared to the baseline parameters , but no significant difference was noted between the two groups . The other investigated objective parameters did not show a significant difference . CONCLUSION Results of our study show that a single LipiFlow treatment is as least as effective as a 3-month , twice-daily lid margin hygiene regimen for MGD . However , the present study was observer-masked only , and therefore a placebo effect may have confounded any improvements in subjective symptoms and other parameters in both groups Background Dysfunction of the meibomian gl and ( MG ) is among the most frequent causes of ophthalmological symptoms . The inflammation seen in meibomian gl and dysfunction ( MGD ) is part of its pathogenesis , and evidence of the antioxidant-inflammatory properties of omega-3 fatty acids suggests this to be an appropriate treatment for MGD . Objective We aim ed to assess the effectiveness of omega-3 fatty acids versus placebo , in improving the symptoms and signs of MGD . Methods We conducted a r and omized and double-mask trial of 3 months duration . We enrolled 61 patients who presented with symptomatic MGD and no tear instability ( defined as tear breakup time [ TBUT ] < 10 seconds ) . Participants were r and omly assigned to two homogeneous subgroups . For patients in group A , the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives , plus a placebo oral agent . For patients in group B , the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives , plus oral supplementation with omega-3 fatty acids . We performed the following tests : ( 1 ) TBUT ; ( 2 ) Schirmer I test ; ( 3 ) Ocular Surface Disease Index © ( OSDI © ; Allergan , Inc. , Irvine , CA , USA ) ; ( 4 ) MG expression ; ( 5 ) evaluation of lid margin inflammation ; and ( 6 ) interpalpebral and corneal dye staining . Results After 3 months of evaluation , the mean OSDI , TBUT , lid margin inflammation , and MG expression presented improvement from the baseline values , in group B ( P < 0.01 , P < 0.001 , P < 0.0001 , P < 0.0001 , respectively ) . The Schirmer test results were also improved and statistically significant ( P < 0.01 ) . Conclusion Oral omega-3 fatty acids , 1.5 grams per day , may be beneficial in the treatment of MGD , mainly by improving tear stability IMPORTANCE The immunopathogenic mechanisms of dry eye disease ( DED ) , one of the most common ophthalmic conditions , is incompletely understood . Data from this prospect i ve , double-masked , r and omized trial demonstrate that targeting interleukin 1 ( IL-1 ) by topical application of an IL-1 antagonist is efficacious in significantly reducing DED-related patient symptoms and corneal epitheliopathy . OBJECTIVE To evaluate the safety and efficacy of treatment with the topical IL-1 receptor antagonist anakinra ( Kineret ; Amgen Inc ) in patients having DED associated with meibomian gl and dysfunction . DESIGN AND SETTING Prospect i ve phase 1/2 , r and omized , double-masked , vehicle-controlled clinical trial . PARTICIPANTS Seventy-five patients with refractory DED . INTERVENTIONS Participants were r and omized to receive treatment with topical anakinra , 2.5 % ( n = 30 ) , anakinra , 5 % ( n = 15 ) , or vehicle ( 1 % carboxymethylcellulose ) ( n = 30 ) 3 times daily for 12 weeks . MAIN OUTCOMES AND MEASURES Primary outcomes were corneal fluorescein staining ( CFS ) , complete bilateral CFS clearance , dry eye-related symptoms as measured by the Ocular Surface Disease Index , tear film breakup time , and meibomian gl and secretion quality . RESULTS Topical anakinra was well tolerated compared with vehicle , with no reports of serious adverse reactions attributable to the therapy . After 12 weeks of therapy , participants treated with anakinra , 2.5 % , achieved a 46 % reduction in their mean CFS score ( P = .12 compared with vehicle and P < .001 compared with baseline ) ; participants treated with anakinra , 5 % , achieved a 17 % reduction in their mean CFS score ( P = .88 compared with vehicle and P = .33 compared with baseline ) ; and patients treated with vehicle achieved a 19 % reduction in their mean CFS score ( P = .11 ) . Complete bilateral CFS clearance was noted in 8 of 28 patients ( 29 % ) treated with anakinra , 2.5 % , vs in 2 of 29 patients ( 7 % ) treated with vehicle ( P = .03 ) . By week 12 , treatment with anakinra , 2.5 % , and treatment with anakinra , 5 % , led to significant reductions in symptoms of 30 % and 35 % , respectively ( P = .02 and P = .01 , respectively , compared with vehicle ) ; treatment with vehicle led to a 5 % reduction in symptoms . CONCLUSIONS AND RELEVANCE Treatment with topical anakinra , 2.5 % , for 12 weeks was safe and significantly reduced symptoms and corneal epitheliopathy in patients with DED . These data suggest that the use of an IL-1 antagonist may have a role as a novel therapeutic option for patients with DED . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00681109 PURPOSE This study aim ed to compare the efficacy of topical N-acetyl-cysteine ( NAC ) with a topical steroid-antibiotic combination , betamethasone-sulfacetamide sodium therapy in patients with meibomian gl and dysfunction ( MGD ) . METHODS Twenty patients with MGD were prospect ively r and omized and assigned into 2 groups . The patients were instructed to use either NAC 5 % or a topical steroid-antibiotic combination , betamethasone 0.1%-sulfacetamide sodium 10 % , topically 4 times a day for a month . All patients were instructed to apply lid hygiene once daily . RESULTS One month of topical therapy provided statistically significant improvements in fluorescein break-up time and Schirmer scores as compared with the initial study visit in both groups ( P≤0.001 ) . Significant improvements for the symptoms of ocular burning , itching , and intermittent filmy or blurred vision were noted in both groups at 1 month as compared with 1 day ( P<0.05 ) . Considering these rates , there was no significant difference between the groups ( P>0.05 ) . None of the patients developed an allergic reaction to the medications , and intraocular pressure measurements were within the normal limits in both groups . CONCLUSION When used in conjunction with eyelid hygiene , topical administration of NAC appears to be as effective as a topical steroid-antibiotic combination , betamethasone-sulfacetamide sodium therapy in patients with MGD Purpose To evaluate the safety and effectiveness of the LipiFlow System compared to the iHeat Warm Compress ( WC ) for adults with meibomian gl and dysfunction ( MGD ) . Methods This was a non-significant risk , prospect i ve , open-label , r and omized , crossover multicenter clinical trial . One hundred thirty-nine subjects were r and omized between LipiFlow ( n=69 ) and WC control ( n=70 ) . Subjects in the LipiFlow group received a 12-minute LipiFlow treatment and were reexamined at 1 day , 2 weeks and 4 weeks . Control subjects received a 5-minute iHeat treatment with instructions to perform the same treatment daily for 2 weeks . At 2 weeks , they crossed over ( LipiFlow Crossover ) and received the LipiFlow  treatment . Effectiveness parameters : meibomian gl and ( MG ) assessment , tear break-up time ( TBUT ) and dry eye symptoms . Safety parameters : adverse events , ocular health exam , ocular surface staining , intraocular pressure , visual acuity and discomfort . Results LipiFlow result ed in significant improvement ( P < 0.05 ) in MG secretion at 2 and 4 weeks ( mean ± st and ard deviation at baseline = 6.3 ± 3.5 ; 2 weeks = 14.3 ± 8.7 ; 4 weeks = 16.7 ± 8.7 ) ; and TBUT at 2 and 4 weeks : ( at baseline = 5.5 ± 2.9 ; 2 weeks = 6.9 ± 5.0 ; 4 weeks = 7.4 ± 5.5 ) . There was no significant change in MG secretion or TBUT in the control group . LipiFlow result ed in a greater significant reduction in dry eye symptoms than the iHeat WC . The crossover group demonstrated similar significant improvement 2 weeks post-treatment with the LipiFlow . There was no significant difference between groups in the incidence of non-serious , device-related adverse events . Conclusion The LipiFlow System was significantly more effective than iHeat WC . These results support its safety and effectiveness in the treatment of MGD and dry eye symptoms Purpose : To compare the efficacy of topical cyclosporine [ 0.05 % cyclosporine A ( CsA ) ] and preservative-free artificial tears in the treatment of meibomian gl and dysfunction ( MGD ) . Methods : A 3-month prospect i ve , r and omized , double-masked , parallel-group controlled trial enrolled 70 patients with symptomatic MGD and unstable tear film [ tear breakup time ( TBUT ) < 8 seconds ] . Patients were r and omized to topical CsA ( 0.05 % ; group A ) and 0.5 % carboxymethylcellulose ( control ; group B ) instilled twice daily for 3 months . Ocular Surface Disease Index ( OSDI ) , lid margin inflammation , meibomian gl and expression , conjunctival injection , corneal and interpalpebral dye staining , noninvasive tear breakup time ( NIBUT ) using the Tearscope Plus and invasive fluorescein tear breakup time ( FBUT ) , and Schirmer I test were performed . Results : At the 3-month evaluation , mean OSDI , NIBUT and FBUT , lid margin inflammation , meibomian gl and expressibility , and tarsal injection showed significant improvement from baseline in group A ( P < 0.01 , P < 0.01 , P < 0.001 , P < 0.05 , and P < 0.001 , respectively ) . In group B , only the OSDI improved significantly from baseline at 3 months ( P = 0.003 ) . TBUTs ( NIBUT and FBUT ) were significantly longer in group A at all visits , and the mean change of TBUTs from baseline was also significantly greater in group A at 3 months ( P < 0.001 ) . Conclusions : Topical CsA 0.05 % twice daily may be helpful in the treatment of MGD mainly by improving tear film stability Background / aims To investigate the efficacy and safety of the MGDRx EyeBag ( The Eyebag Company , Halifax , UK ) eyelid warming device . Methods Twenty-five patients with confirmed meibomian gl and dysfunction (MGD)-related evaporative dry eye were enrolled into a r and omised , single masked , contralateral clinical trial . Test eyes received a heated device ; control eyes a non-heated device for 5 min twice a day for 2 weeks . Efficacy ( ocular symptomology , non-invasive break-up time , lipid layer thickness , osmolarity , meibomian gl and dropout and function ) and safety ( visual acuity , corneal topography , conjunctival hyperaemia and staining ) measurements were taken at baseline and follow-up . Subsequent patient device usage and ocular comfort was ascertained at 6 months . Results Differences between test and control eyes at baseline were not statistically significant for all measurements ( p>0.05 ) . After 2 weeks , statistically significant improvements occurred in all efficacy measurements in test eyes ( p<0.05 ) . Visual acuity and corneal topography were unaffected ( p>0.05 ) . All patients maintained higher ocular comfort after 6 months ( p<0.05 ) , although the 
    Output:
    
agent
No quantitative synthesis was attempted for either mebiomian plugging or meibomian secretion scores and no significant changes were observed with any other outcome parameter .
Conclusion : Only the systemic antimicrobials were found to improve the clinical features of meibomian gl and dysfunction .
Varying effects of different therapeutic agents ( heat therapies , omega-3-fatty acids and castor oil ) were identified for MGD but the risk of bias pertaining to r and omization and allocation concealment was found to be associated with most of the current RCTs .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To compare the effectiveness of a single LipiFlow ( ® ) treatment with combined lid warming and massage in patients with meibomian gl and dysfunction ( MGD ) . METHODS In this prospect i ve , r and omized , crossover , observer-masked clinical trial , subjects were r and omized to receive either a single 12-min LipiFlow-LipiFlow Thermal Pulsation ( LTP ) system treatment or to perform combined twice-daily lid warming and massage for 3 months . All subjects were examined before , and 1 and 3 months after initiation of treatments . Investigated parameters included subjective symptoms , lipid layer thickness , meibomian gl and assessment , tear break-up time , tear osmolarity , corneal and conjunctival staining , Schirmer test values , and tear meniscus height . RESULTS A total of 31 subjects completed the 3-month follow-up . At 1 and 3 months , patients in the LipiFlow treatment group had a significant reduction in Ocular Surface Disease Index ( OSDI ) scores compared with those in the lid-margin hygiene group . Both treatments produced a significant improvement in expressible meibomian gl and s compared to the baseline parameters , but no significant difference was noted between the two groups . The other investigated objective parameters did not show a significant difference . CONCLUSION Results of our study show that a single LipiFlow treatment is as least as effective as a 3-month , twice-daily lid margin hygiene regimen for MGD . However , the present study was observer-masked only , and therefore a placebo effect may have confounded any improvements in subjective symptoms and other parameters in both groups Background Dysfunction of the meibomian gl and ( MG ) is among the most frequent causes of ophthalmological symptoms . The inflammation seen in meibomian gl and dysfunction ( MGD ) is part of its pathogenesis , and evidence of the antioxidant-inflammatory properties of omega-3 fatty acids suggests this to be an appropriate treatment for MGD . Objective We aim ed to assess the effectiveness of omega-3 fatty acids versus placebo , in improving the symptoms and signs of MGD . Methods We conducted a r and omized and double-mask trial of 3 months duration . We enrolled 61 patients who presented with symptomatic MGD and no tear instability ( defined as tear breakup time [ TBUT ] < 10 seconds ) . Participants were r and omly assigned to two homogeneous subgroups . For patients in group A , the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives , plus a placebo oral agent . For patients in group B , the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives , plus oral supplementation with omega-3 fatty acids . We performed the following tests : ( 1 ) TBUT ; ( 2 ) Schirmer I test ; ( 3 ) Ocular Surface Disease Index © ( OSDI © ; Allergan , Inc. , Irvine , CA , USA ) ; ( 4 ) MG expression ; ( 5 ) evaluation of lid margin inflammation ; and ( 6 ) interpalpebral and corneal dye staining . Results After 3 months of evaluation , the mean OSDI , TBUT , lid margin inflammation , and MG expression presented improvement from the baseline values , in group B ( P < 0.01 , P < 0.001 , P < 0.0001 , P < 0.0001 , respectively ) . The Schirmer test results were also improved and statistically significant ( P < 0.01 ) . Conclusion Oral omega-3 fatty acids , 1.5 grams per day , may be beneficial in the treatment of MGD , mainly by improving tear stability IMPORTANCE The immunopathogenic mechanisms of dry eye disease ( DED ) , one of the most common ophthalmic conditions , is incompletely understood . Data from this prospect i ve , double-masked , r and omized trial demonstrate that targeting interleukin 1 ( IL-1 ) by topical application of an IL-1 antagonist is efficacious in significantly reducing DED-related patient symptoms and corneal epitheliopathy . OBJECTIVE To evaluate the safety and efficacy of treatment with the topical IL-1 receptor antagonist anakinra ( Kineret ; Amgen Inc ) in patients having DED associated with meibomian gl and dysfunction . DESIGN AND SETTING Prospect i ve phase 1/2 , r and omized , double-masked , vehicle-controlled clinical trial . PARTICIPANTS Seventy-five patients with refractory DED . INTERVENTIONS Participants were r and omized to receive treatment with topical anakinra , 2.5 % ( n = 30 ) , anakinra , 5 % ( n = 15 ) , or vehicle ( 1 % carboxymethylcellulose ) ( n = 30 ) 3 times daily for 12 weeks . MAIN OUTCOMES AND MEASURES Primary outcomes were corneal fluorescein staining ( CFS ) , complete bilateral CFS clearance , dry eye-related symptoms as measured by the Ocular Surface Disease Index , tear film breakup time , and meibomian gl and secretion quality . RESULTS Topical anakinra was well tolerated compared with vehicle , with no reports of serious adverse reactions attributable to the therapy . After 12 weeks of therapy , participants treated with anakinra , 2.5 % , achieved a 46 % reduction in their mean CFS score ( P = .12 compared with vehicle and P < .001 compared with baseline ) ; participants treated with anakinra , 5 % , achieved a 17 % reduction in their mean CFS score ( P = .88 compared with vehicle and P = .33 compared with baseline ) ; and patients treated with vehicle achieved a 19 % reduction in their mean CFS score ( P = .11 ) . Complete bilateral CFS clearance was noted in 8 of 28 patients ( 29 % ) treated with anakinra , 2.5 % , vs in 2 of 29 patients ( 7 % ) treated with vehicle ( P = .03 ) . By week 12 , treatment with anakinra , 2.5 % , and treatment with anakinra , 5 % , led to significant reductions in symptoms of 30 % and 35 % , respectively ( P = .02 and P = .01 , respectively , compared with vehicle ) ; treatment with vehicle led to a 5 % reduction in symptoms . CONCLUSIONS AND RELEVANCE Treatment with topical anakinra , 2.5 % , for 12 weeks was safe and significantly reduced symptoms and corneal epitheliopathy in patients with DED . These data suggest that the use of an IL-1 antagonist may have a role as a novel therapeutic option for patients with DED . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00681109 PURPOSE This study aim ed to compare the efficacy of topical N-acetyl-cysteine ( NAC ) with a topical steroid-antibiotic combination , betamethasone-sulfacetamide sodium therapy in patients with meibomian gl and dysfunction ( MGD ) . METHODS Twenty patients with MGD were prospect ively r and omized and assigned into 2 groups . The patients were instructed to use either NAC 5 % or a topical steroid-antibiotic combination , betamethasone 0.1%-sulfacetamide sodium 10 % , topically 4 times a day for a month . All patients were instructed to apply lid hygiene once daily . RESULTS One month of topical therapy provided statistically significant improvements in fluorescein break-up time and Schirmer scores as compared with the initial study visit in both groups ( P≤0.001 ) . Significant improvements for the symptoms of ocular burning , itching , and intermittent filmy or blurred vision were noted in both groups at 1 month as compared with 1 day ( P<0.05 ) . Considering these rates , there was no significant difference between the groups ( P>0.05 ) . None of the patients developed an allergic reaction to the medications , and intraocular pressure measurements were within the normal limits in both groups . CONCLUSION When used in conjunction with eyelid hygiene , topical administration of NAC appears to be as effective as a topical steroid-antibiotic combination , betamethasone-sulfacetamide sodium therapy in patients with MGD Purpose To evaluate the safety and effectiveness of the LipiFlow System compared to the iHeat Warm Compress ( WC ) for adults with meibomian gl and dysfunction ( MGD ) . Methods This was a non-significant risk , prospect i ve , open-label , r and omized , crossover multicenter clinical trial . One hundred thirty-nine subjects were r and omized between LipiFlow ( n=69 ) and WC control ( n=70 ) . Subjects in the LipiFlow group received a 12-minute LipiFlow treatment and were reexamined at 1 day , 2 weeks and 4 weeks . Control subjects received a 5-minute iHeat treatment with instructions to perform the same treatment daily for 2 weeks . At 2 weeks , they crossed over ( LipiFlow Crossover ) and received the LipiFlow  treatment . Effectiveness parameters : meibomian gl and ( MG ) assessment , tear break-up time ( TBUT ) and dry eye symptoms . Safety parameters : adverse events , ocular health exam , ocular surface staining , intraocular pressure , visual acuity and discomfort . Results LipiFlow result ed in significant improvement ( P < 0.05 ) in MG secretion at 2 and 4 weeks ( mean ± st and ard deviation at baseline = 6.3 ± 3.5 ; 2 weeks = 14.3 ± 8.7 ; 4 weeks = 16.7 ± 8.7 ) ; and TBUT at 2 and 4 weeks : ( at baseline = 5.5 ± 2.9 ; 2 weeks = 6.9 ± 5.0 ; 4 weeks = 7.4 ± 5.5 ) . There was no significant change in MG secretion or TBUT in the control group . LipiFlow result ed in a greater significant reduction in dry eye symptoms than the iHeat WC . The crossover group demonstrated similar significant improvement 2 weeks post-treatment with the LipiFlow . There was no significant difference between groups in the incidence of non-serious , device-related adverse events . Conclusion The LipiFlow System was significantly more effective than iHeat WC . These results support its safety and effectiveness in the treatment of MGD and dry eye symptoms Purpose : To compare the efficacy of topical cyclosporine [ 0.05 % cyclosporine A ( CsA ) ] and preservative-free artificial tears in the treatment of meibomian gl and dysfunction ( MGD ) . Methods : A 3-month prospect i ve , r and omized , double-masked , parallel-group controlled trial enrolled 70 patients with symptomatic MGD and unstable tear film [ tear breakup time ( TBUT ) < 8 seconds ] . Patients were r and omized to topical CsA ( 0.05 % ; group A ) and 0.5 % carboxymethylcellulose ( control ; group B ) instilled twice daily for 3 months . Ocular Surface Disease Index ( OSDI ) , lid margin inflammation , meibomian gl and expression , conjunctival injection , corneal and interpalpebral dye staining , noninvasive tear breakup time ( NIBUT ) using the Tearscope Plus and invasive fluorescein tear breakup time ( FBUT ) , and Schirmer I test were performed . Results : At the 3-month evaluation , mean OSDI , NIBUT and FBUT , lid margin inflammation , meibomian gl and expressibility , and tarsal injection showed significant improvement from baseline in group A ( P < 0.01 , P < 0.01 , P < 0.001 , P < 0.05 , and P < 0.001 , respectively ) . In group B , only the OSDI improved significantly from baseline at 3 months ( P = 0.003 ) . TBUTs ( NIBUT and FBUT ) were significantly longer in group A at all visits , and the mean change of TBUTs from baseline was also significantly greater in group A at 3 months ( P < 0.001 ) . Conclusions : Topical CsA 0.05 % twice daily may be helpful in the treatment of MGD mainly by improving tear film stability Background / aims To investigate the efficacy and safety of the MGDRx EyeBag ( The Eyebag Company , Halifax , UK ) eyelid warming device . Methods Twenty-five patients with confirmed meibomian gl and dysfunction (MGD)-related evaporative dry eye were enrolled into a r and omised , single masked , contralateral clinical trial . Test eyes received a heated device ; control eyes a non-heated device for 5 min twice a day for 2 weeks . Efficacy ( ocular symptomology , non-invasive break-up time , lipid layer thickness , osmolarity , meibomian gl and dropout and function ) and safety ( visual acuity , corneal topography , conjunctival hyperaemia and staining ) measurements were taken at baseline and follow-up . Subsequent patient device usage and ocular comfort was ascertained at 6 months . Results Differences between test and control eyes at baseline were not statistically significant for all measurements ( p>0.05 ) . After 2 weeks , statistically significant improvements occurred in all efficacy measurements in test eyes ( p<0.05 ) . Visual acuity and corneal topography were unaffected ( p>0.05 ) . All patients maintained higher ocular comfort after 6 months ( p<0.05 ) , although the 
    Output:
    