Meibomian Gland Dysfunction and Tear Lipid Layer Analysis after Cataract Surgery

Ju Heun Oh; Chang Hyun Park; Woong Joo Whang; Kyung Sun Na; Hyun Seung Kim

doi:10.3341/jkos.2019.60.6.519

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Oh, Park, Whang, Na, and Kim: Meibomian Gland Dysfunction and Tear Lipid Layer Analysis after Cataract Surgery

Original Article

Journal of the Korean Ophthalmological Society 2019; 60(6): 519-527.

Published online: 17 June 2019

DOI: https://doi.org/10.3341/jkos.2019.60.6.519

Meibomian Gland Dysfunction and Tear Lipid Layer Analysis after Cataract Surgery

Ju Heun Oh, MD, Chang Hyun Park, MD, Woong Joo Whang, MD, Kyung Sun Na, MD, PhD, Hyun Seung Kim, MD, PhD

Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Address reprint requests to Hyun Seung Kim, MD, PhD. Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #10 63-ro, Yeongdeungpo-gu, Seoul 07345, Korea. Tel: 82-2-1661-7575, Fax: 82-2-761-6869, sara514@catholic.ac.kr

Received 13 December 2018 Revised 15 January 2019 Accepted 17 May 2019

The Korean Ophthalmological Society

(open-access):

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

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.

Keywords: Cataract surgery, Dry eye syndrome, Meibomian gland, Tear film lipid layer thickness

Figures and Tables

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).

Table 1

Demographics of study group

Values are presented as mean ± standard deviation unless otherwise indicated.

OD:OS = oculus dexter:oculus sinister; M:F = male:female; OSDI = ocular surface disease index; tBUT = tear break up time; LLT = lipid layer thickness.

Table 2

The follow up data after cataract surgery

Values are presented as mean ± standard deviation unless otherwise indicated.

Preop = preoperative; Postop = postoperative; OSDI = ocular surface disease index; tBUT = tear break up time; LLT = lipid layer thickness.

^*Significant correlations (p < 0.05); ^†repeated-measures analysis of variance.

Table 3

Change in lid parameters of MGD before cataract surgery and postop 2 months

Compare to lid margin abnormality, drop out, tortuosity, ectasis, grade from preoperative value. There was no statistically significant difference between 2 months postoperatively and preoperative value (p > 0.05). Values are presented as mean ± standard deviation unless otherwise indicated.

MGD = meibomian gland dysfunction; Preop = preoperative; Postop = postoperative.

^*Wilcoxon signed rank test, compared with preoperative values. p < 0.05 were considered statistically significant, significant correlations (p < 0.05).

Table 4

Preoperative characteristics of groups stratified by Meibomian gland disese

Table 5

The follow up data after cataract surgery compare with obstructive and seborrheic MGD

LLT was significantly higher in obstructive MGD at preoperative value, 1 week, 1 and 2 months postoperatively compared to obstructive and seborrheic MGD. tBUT was significantly short in obstructive MGD at 1 week postoperatively compared to obstructive and seborrheic MGD. Meibomian gland expressibility was significantly higher in seborrheic MGD at preoperative value, 1 week, 1 and 2 months postoperatively compared to obstructive and seborrheic MGD. There was no statistically significant difference in OSDI, Corneal staining score, partial blink compared to obstructive and seborrheic MGD. Values are presented as mean ± standard deviation unless otherwise indicated.

MGD = meibomian gland dysfunction; LLT = lipid layer thickness; tBUT = tear break up time; OSDI = ocular surface disease index.

^*p < 0.05 were considered statistically significant, significant correlations (p < 0.05); ^†Wilcoxon signed rank test compared with preoperative values.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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