A Note on Literature Review Related to “Oral Azithromycin Versus Oral Doxycycline in the Treatment of Meibomian Gland Dysfunction: A Systematic Review and Meta-Analysis” [Letter]

Dear editor

We are writing in reference to the article titled “Oral Azithromycin versus Oral Doxycycline in the Treatment of Meibomian Gland Dysfunction: A Systematic Review and Meta-Analysis” recently published in Clinical Ophthalmology.¹ While the article makes an important contribution to the literature, we wanted to humbly bring to your attention another relevant study that could have complemented the discussion and findings presented by the authors.

Our meta-analysis, recently published in Acta Ophthalmologica,² systematically reviewed and analyzed 54 eligible studies, ultimately including six randomized controlled studies involving 563 cases across three countries assessing the safety and efficacy of macrolides (ie, Azithromycin) versus tetracyclines (ie, Doxycycline) for Meibomian Gland Dysfunction (MGD).

Our findings align with and expand upon those reported in the Clinical Ophthalmology article. Specifically, we found that overall, both treatment methods induced improvement in MGD signs and symptoms. However, macrolides were significantly superior in the total signs score (pooled standardized mean difference (SMD) −0.51, 95% confidence interval (CI): −0.99 to −0.03), meibomian gland secretion score (pooled SMD −0.25, 95% CI: [−0.48, −0.03]), tear break-up Time (TBUT; SMD −0.31, 95% CI: [−0.50, −0.13]) and fluorescein staining score (SMD −1.01, 95% CI: [−1.72, −0.29]). Moreover, while no severe complications were reported for both treatments, the macrolide group exhibited significantly less adverse events (pooled odds ratio 0.24 with a 95% CI of 0.16 to 0.34).

While the authors have conducted a valuable meta-analysis, and have reached parallel conclusions regarding the efficacy and safety of macrolides, it is worth noting that this is not the first systematic review and meta-analysis addressing the efficacy and safety of oral antibiotics for the treatment of MGD. Including our findings, based solely on RCTs according to the Cochrane Society’s guidelines, could have further enriched the article’s discussion, particularly in areas that were not extensively addressed, such as individual sign scores (eg, fluorescein staining and TBUT).

We understand that no study can cover all relevant literature, and we appreciate the thorough work of the authors. Nevertheless, we believe that referencing our findings might provide readers with a more comprehensive view of this topic and contribute to advancing research in the field of MGD.