Analysis of Tear Meniscus Change after Strabismus Surgery Using Optical Coherence Tomography

Ji Hye Kim; Che Ron Kim; Seong Jae Kim; In Young Chung; Seong Wook Seo; Ji Myong Yoo

doi:10.3341/jkos.2016.57.12.1932

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Kim, Kim, Kim, Chung, Seo, and Yoo: Analysis of Tear Meniscus Change after Strabismus Surgery Using Optical Coherence Tomography

Original Article

J Korean Ophthalmol Soc 2016;57(12):1932-1938.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.12.1932

Analysis of Tear Meniscus Change after Strabismus Surgery Using Optical Coherence Tomography

Ji Hye Kim, MD¹, Che Ron Kim, MD¹, Seong Jae Kim, MD, PhD^1,², In Young Chung, MD, PhD^1,², Seong Wook Seo, MD, PhD^1,², Ji Myong Yoo, MD, PhD^1,²

¹Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea

²Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea

Address reprint requests to Ji Myong Yoo, MD, PhD Department of Ophthalmology, Gyeongsang National University Hospital, #79 Gangnam-ro, Jinju 52727, Korea Tel: 82-55-750-8171, Fax: 82-55-758-4158 E-mail: yjm@gnu.ac.kr

Received 14 July 2016 Revised 6 October 2016 Accepted 28 November 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

In this study, the changes in ocular surface parameters and tear meniscus after strabismus surgery when treated with or without artificial tears were evaluated using optical coherence tomography (OCT).

Methods

The present study included 30 patients who received bilateral lateral rectus recession surgery for exotropia. The patients instilled artificial tear eye drops only in the left eye. Before and 2, 4, 8, and 12 weeks after surgery, tear film break-up time (BUT), Schirmer's test, corneal staining test, tear meniscus height and area were measured using OCT and compared in both eyes. Before and 8 weeks after surgery, conjunctival compression cytology test was performed.

Results

The mean patient age was 8.7 years. After 8 weeks, BUT and corneal staining scores were 12.3 ± 1.5 seconds and 1.3 ± 0.4 in patients treated with artificial tears and 9.5 ± 1.0 seconds and 2.0 ± 0.7 in patients not treated with artificial tears (both p < 0.000). Four weeks after surgery, tear meniscus height and area using OCT were 290.2 ± 42.3 μm and 566.7 ± 48.2 pixels in patients treated with artificial tears and 246 ± 45.5 μ m and 504.0 ± 29.7 pixels in patients not treated with artificial tears (p = 0.045 and p = 0.019, respectively). Goblet cell count was significantly different between the eyes 8 weeks after surgery (p = 0.033).

Conclusions

Instability of tear meniscus can be detected after strabismus surgery using BUT, Schirmer's test, corneal staining test, tear meniscus height and area, and OCT. After surgery, artificial tears help treat dry eye symptoms by corneo-conjunctival wound healing mechanism and increasing tear meniscus stability.

Keywords: Optical coherence tomography, Strabismus, Tear meniscus

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Figure 1.

Tear meniscus measurement. (A) Optical coherence tomography image of the lower tear meniscus showing the tear me-niscus height. (B) Optical coherence tomography image of the lower tear meniscus exported to ImageJ software for measuring me-niscus area.

Figure 2.

Impression cytology (Periodic acid-Schiff, ×400). (A) 8 weeks after surgery, specimen from a patient treated artificial tear shows normal nuclear/cytoplasmic ratio and goblet cells. (B) 8 weeks after surgery, specimen from a control group patient shows normal nuclear/cytoplasmic ratio and depletion of goblet cells.

Table 1.

Changes of corneal surface parameters

	Group 1	Group 2	p-value^†
TBUT (sec)
Baseline	14.2 ± 1.9	14.0 ± 1.8	0.683
2 weeks	8.2 ± 2.0^*	6.8 ± 1.3^*	0.030
4 weeks	9.9 ± 1.6^*	8.1 ± 1.2^*	0.000
8 weeks	12.3 ± 1.5^*	9.5 ± 1.0^*	0.000
12 weeks	14.0 ± 1.3	13.6 ± 1.8	0.417
Schirmer test (mm)
Baseline	20.9 ± 2.2	21.5 ± 2.7	0.329
2 weeks	19.0 ± 3.0^*	20.4 ± 2.8	0.061
4 weeks	19.5 ± 2.4	19.1 ± 2.5^*	0.534
8 weeks	21.2 ± 2.4	22.3 ± 2.6	0.089
12 weeks	19.7 ± 2.0	20.2 ± 2.5	0.441
Corneal staining score
Baseline	0.1 ± 0.3	0.1 ± 0.3	0.694
2 weeks	5.1 ± 1.7^*	6.0 ± 1.4^*	0.024
4 weeks	2.2 ± 0.8^*	4.1 ± 0.7^*	0.000
8 weeks	1.3 ± 0.4^*	2.0 ± 0.7^*	0.000
12 weeks	0.2 ± 0.4	0.2 ± 0.4	0.759

Values are the mean ± standard deviation unless otherwise indicated. TBUT = tear break up time.

^* p < 0.05 Paired t-rest Group 1 compared with baseline and Group 2 compared with baseline; † Independent t-test between Group 1 and Group 2.

Table 2.

Changes of tear meniscus height and area

	Group 1	Group 2	p-value^†
Height (μ m)
Baseline	294.7 ± 35.4	286 ± 42.5	0.476
2 weeks	288.3 ± 52.5	236 ± 38.7^*	0.037
4 weeks	290.2 ± 42.3	246 ± 45.5^*	0.045
8 weeks	296.5 ± 47.2	279 ± 31.9	0.144
12 weeks	292.1 ± 57.3	295 ± 44.3	0.743
Area (pixels)
Baseline	601.6 ± 52.1	587.4 ± 65.3	0.374
2 weeks	553.1 ± 57.6^*	503.7 ± 40.8^*	0.021
4 weeks	566.7 ± 48.2	504.0 ± 29.7^*	0.019
8 weeks	588.4 ± 60.5	578.9 ± 56.6	0.624
12 weeks	579.3 ± 51.9	584.2 ± 48.7	0.771

Values are the mean ± standard deviation unless otherwise indicated.

^* p < 0.05 Paired t-rest Group 1 compared with baseline and Group 2 compared with baseline

^† Independent t-test between Group 1 and Group 2.

Table 3.

Changes of impression cytological findings

	Group 1	Group 2	p-value^†
Keratoepitheliopathy score
Baseline	0.1 ± 0.2	0.1 ± 0.3	0.897
8 weeks	0.1 ± 0.3	0.1 ± 0.4	0.796
Goblet cell density (cells/mm²)
Baseline	196.6 ± 100.1	212.3 ± 122.3	0.464
8 weeks	182.3 ± 89.7	127.4 ± 101.6^*	0.033

Values are the mean ± standard deviation unless otherwise indicated.

^* p < 0.05 Paired t-rest Group 1 compared with baseline and Group 2 compared with baseline

^† Independent t-test between Group 1 and Group 2.

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