J Korean Ophthalmol Soc.  2019 Jun;60(6):519-527. 10.3341/jkos.2019.60.6.519.

Meibomian Gland Dysfunction and Tear Lipid Layer Analysis after Cataract Surgery

• Oh JH
• Park CH
• Whang WJ
• Na KS
• Kim HS

• KMID: 2449704
• DOI: http://doi.org/10.3341/jkos.2019.60.6.519

Abstract

PURPOSE
We report the clinical manifestations of dry eye syndrome after cataract surgery involving meibomian gland structure, meibomian gland function, and tear lipid layer analysis.
METHODS
The clinical manifestations of dry eye syndrome were retrospectively evaluated in 34 eyes of 31 patients who underwent cataract surgery from September to November 2017. The ocular surface disease index (OSDI), tear break-up time (tBUT), Oxford stain score, presence or absence of blepharitis, and meibomian gland expression were measured preoperatively and at 1 week, 1 month, and 2 months postoperatively. Lipid layer thickness (LLT), partial blinks, and meibomian gland images were measured using LipiView® (TearScience, Morrisville, NC, USA), an interferometric eye surface measuring device.
RESULTS
The postoperative OSDI was significantly higher than preoperative OSDI (17.09 ± 1.81): 22.76 ± 1.99 at 1 week, 23.12 ± 1.91 at 1 month, and 22.68 ± 1.92 at 2 months (p < 0.05). The postoperative tBUT was significantly lower than preoperative tBUT (5.07 ± 0.39): 3.99 ± 0.31 at 1 week, 3.49 ± 0.27 at 1 month, and 4.72 ± 0.39 at 2 months (p < 0.05). The Oxford staining score increased after surgery, but the difference was not statistically significant. Postoperative meibomian gland expression was significantly lower preoperative values (4.9 ± 2.8): 4.4 ± 2.8 at 1 month, and 3.9 ± 2.8 at 2 months (p < 0.05). The LLT decreased at 1 month postoperatively and increased at 2 months postoperatively, but these differences were not statistically significant.
CONCLUSIONS
Cataract surgery resulted in a short-term meibomian gland dysfunction, leading to deterioration of dry eye after cataract surgery. However, we could not confirm structural changes in the meibomian gland, so it will be necessary to observe the clinical features of dry eye syndrome over a longer period of time.

Keyword

Cataract surgery; Dry eye syndrome; Meibomian gland; Tear film lipid layer thickness

MeSH Terms

Blepharitis
Cataract*
Dry Eye Syndromes
Humans
Meibomian Glands*
Retrospective Studies
Tears*

Figure

• 

  Figure 1 Images of Meibomian gland drop out, tortuosity, ectasis cases of meibographs, captured by LipiView® (TearScience, Morrisville, NC, USA). Meibography image analysis examples. The freehand tool in ImageJ was used to select the area of meibomian gland, and computerized analysis of the area of Meibomian gland. (A) Meibomian gland drop out, partial or total gland loss or atrophy. (B) Meibomian gland tortuosity. (C) Meibomian gland ectasis, partial or total gland dilatation.

• 

  Figure 2 The grading of Meibomian gland loss. Partial or complete loss of Meibomian gland is scored for each eyelid from grade 0 to grade 3. (A) Grade 0 means no loss of meibomian glands, normal Meibomian gland. (B) Grade 1 means the lost area was less than 1/3 of total area. (C) Grade 2 means the lost area was between 1/3 and 2/3 of total area. (D) Grade 3 means the lost area was more than 2/3 of total area.

• 

  Figure 3 Analysis of the Meibomian gland expressibility, lipid layer thickness, Ocular surface disease index (OSDI), tear film break-up time preop and postop. (A) Change in OSDI from preoperative value. The increase in OSDI was statistically significant at 1 week, 1 and 2 months postoperatively compared to preoperative value (p < 0.05). (B) Change in tear break-up time (tBUT) from preoperative value. tBUT was significantly short at 1 week, 1 and 2 months postoperatively compared to the preoperative value (p < 0.05). (C) Change in corneal staining score from preoperative value. There was an increase in the corneal staining score at 1 week, 1 and 2 months postoperatively (p > 0.05). (D) Change in Meibomian gland expressibility from preoperative value. Meibomian gland expressibility was significantly decreased at 1 and 2 months postoperatively compared to the preoperative value (p < 0.05). (E) Change in lipid layer thickness from preoperative value (p > 0.05). (F) Change in partial blink from preoperative value (p > 0.05). Repeated-measures analysis of variance, compared with preoperative values. Preop = preoperative; Postop = postoperative; w = week(s); m = month(s). *Significant correlations (p < 0.05).

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