Meibomian Gland Morphology Changes After Cataract Surgery: A Contra-Lateral Eye Study

Dry eye post-cataract surgery: a systematic review and meta-analysis

SIGNIFICANCE

Cataract surgery is one of the most performed surgical procedures worldwide. As a potential complication following cataract surgery, dry eye has the potential to impact visual outcomes, lower patient satisfaction, and be detrimental to quality of life.

PURPOSE

To evaluate the effect of cataract surgery on dry eye outcomes postoperatively.

METHODS

We searched Ovid MEDLINE and Embase from 01/01/2010 to 16/08/2021 and included observational studies of participants ≥ 18 years old undergoing any cataract surgical procedure. We compared postoperative dry eye outcomes with baseline including Ocular Surface Disease Index (OSDI), tear break up time (TBUT), Schirmer's I test (ST1), and corneal fluorescein staining (CFS) at short-term (< 1 week) and medium-term (≥ 1 week to 3 months) follow-up.

RESULTS

Our search yielded 11,133 records. After title and abstract, and then full text screening, we included 20 studies with 1,694 eyes. There was some evidence indicating a decrease in the TBUT during the short-term (within 1 week) and medium-term (1 week up to 3 months) periods following cataract surgery. There was a considerable degree of heterogeneity between studies across other outcomes. At medium-term follow-up most studies that reported ST1 and CFS showed deterioration of these outcomes but there was conflicting evidence of the effect of cataract surgery on OSDI. The review is limited by variability in follow-up timeframes which were unable capture potential clinical course like peak occurrence and duration.

CONCLUSION

Dry eye may persist up to three months postoperatively following cataract surgery. Further studies are required to determine if dry eye outcomes return to baseline at longer term follow-up.

Vectored Thermal Pulsation as a Treatment for Meibomian Gland Dysfunction: A Review Spanning 15 Years

The LipiFlow Thermal Pulsation System received its first marketing clearance for the treatment of meibomian gland dysfunction (MGD) 13 years ago. Since then, the evidence evaluating the effectiveness and safety of LipiFlow as a treatment for MGD has grown significantly. The objective of this comprehensive review was to summarize all clinical reports evaluating the effectiveness and safety of LipiFlow over the past 15 years. The literature was systematically reviewed, and 55 unique articles had subjective (patient-reported outcomes) and objective (meibomian gland function, tear production, and ocular staining) outcomes for extraction. Data were collected from 2101 patients and 3521 eyes treated with LipiFlow. Of these, effectiveness was evaluated in 2041 patients and 3401 eyes, and safety was evaluated in 1448 patients and 2443 eyes. Taken together, the studies demonstrate that a single 12-min treatment with LipiFlow safely improves signs and symptoms of MGD and associated evaporative dry eye disease (DED), and the benefits persist up to 3 years in some cases. The findings are corroborated by multiple meta-analyses and consensus guidelines. While some studies showed that daily eyelid hygiene, warm compress, and/or massage had a similar benefit to a single LipiFlow, these treatments were limited by inconvenience, discomfort, and non-compliance. The majority of studies evaluating safety reported no discomfort or pain associated with LipiFlow treatment, which supports the patient acceptability of LipiFlow therapy. All adverse events (AEs) related to LipiFlow were transient, non-vision-threatening, and did not require treatment. No studies reported serious AEs. The data obtained from 55 studies conducted globally overwhelmingly show that LipiFlow is effective and safe for the treatment of MGD and associated evaporative DED. The conclusions are supported by the diversity of the patient populations (geography, race, disease severity, and diagnosis), the large population treated with LipiFlow, the meta-analyses, and that this review analyzed all published clinical studies to date.

Risk Factors for Meibomian Gland Disease Assessed by Meibography

Purpose

To elucidate risk factors for meibomian gland disease (MGD) and understand associated changes in meibography and in relation to ocular surface disease.

Patients and Methods

As part of the standard workup for ocular surface disease at a tertiary academic center, 203 patients received an ocular history and lifestyle questionnaire. The questionnaire included detailed inquiries about ocular health and lifestyle, including makeup use, cosmetic eyelid procedures, screen time, and contact lens habits. Subjects also took the standardized patient evaluation of eye dryness (SPEED) II questionnaire. Meibomian gland (MG) dropout and structural changes were evaluated on meibography and scored by three independent graders using meiboscores. Statistical analysis was conducted to identify significant risk factors associated with MG loss.

Results

This retrospective, cross-sectional study included 189 patients (378 eyes) with high-quality images for grading, and the average age was 67 years (77% female). Patients older than 45 years had significantly more dropout than younger patients (p < 0.01). Self-reported eye makeup use did not significantly impact MG loss. Patients with a history of blepharoplasty trended toward higher meiboscores, but the difference was not statistically significant. Self-reported screen time did not affect meiboscores. Contact lens use over 20 years was associated with significant MG loss (p < 0.05). SPEED II scores had no relationship to meiboscores (p = 0.75).

Conclusion

Older age is a significant risk factor for MG loss. Any contact lens use over 20 years also impacted MG dropout. Highlighting the incongruence of symptoms to signs, SPEED II scores showed no relationship to the structural integrity of MGs.

Evaluation of the effect of eyelid disorder surgeries on tears and anterior segment parameters with meibography and corneal topography

Background/Aim: Abnormalities of eyelid shape, including ptosis, entropion, ectropion, lagophthalmos, and dermatochalasis, can occur at any age and affects the patient’s life quality, visual functions, and comfort. These abnormalities can be regarded as illnesses and can be cured medically and surgically. Meibomian glands are large sebaceous glands located in the lower and upper eyelids. Our study aimed to observe changes in anterior cornea segment parameters and meibomian glands of patients undergoing surgery for eyelid shape abnormalities. Methods: Our sample comprised 31 patients, who were operated on at Afyonkarahisar Health Sciences University Hospital, were examined with respect to cornea topographic measurements and the drop-out of meibomian glands at the pre-operative and first-month post-operative processes and post-operative third month. In this prospective cohort method study, the surgical eyes of the patients were determined as the study group and the healthy eyes as the control group. Results: Surgical and healthy eyes of 31 patients were included in this study (N=62). The sample comprised 18 male and 13 female patients. The average age and standard deviation values of patients were determined as 66.50 (17.315) in males and 65.92 (13.714) (P = 0.659) in females. In terms of anterior cornea segment parameters (K1, K2, ACA, ACD, ACV, and CCT), no prominent differences were found in pre-operative and post-operative results (K1, K2, ACA, ACD, ACV, and CCT) in both the study and control groups. Meibography revealed that the increased meibomian gland drop-out of surgical eye measurements of pre- and post-operative was statistically significant (P < 0.001), whereas the change seen in healthy eyes was not statistically significant (P = 0.051). Furthermore, although the change through meibomian glands of entropion patients was not significant (P = 0.066), the drop-out of the meibomian gland of the other surgery cases (ptosis, ectropion, lagophthalmos, blepharoplasty, and dermatochalasis surgery) was found to be statistically significant (P = 0.038). Conclusion: Surgeries to correct abnormalities in eyelid shape can lead patients to meibomian gland drop-out. Pre-operative assessment of patients whose surgeries are planned, and post-operative monitoring, must be done meticulously in order to minimize the likelihood of symptoms and avoid meibomian gland dysfunction.

Alterations in the ocular surface and tear film following keratoplasty

The purpose of this study was to evaluate any alterations in the tear film and ocular surface beyond the early postoperative period following penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK). This cross-sectional, contralateral-eye study compared ocular surface and tear film parameters of eyes with a previous PK or DALK in one eye and no prior surgery in the contralateral eye. Overall, 14 (87.5%) participants underwent PK, and 2 (12.5%) underwent DALK using a mechanical dissection. The median time from surgery was 3.4 years (range 1.5 to 38.7 years). The indication for unilateral keratoplasty was keratoconus in 15 (94%) participants, and corneal scarring in 1 (6%) eye, secondary to microbial keratitis. Operated eyes exhibited poorer non-invasive tear film breakup time, lower corneal sensitivity, lower sub-basal nerve density and more severe fluorescein staining scores than unoperated fellow eyes (all Q < 0.05). There were no significant differences in tear film lipid layer quality, tear meniscus height, conjunctival hyperaemia, lissamine green staining score, or meibography grade between operated and fellow eyes (all Q ≥ 0.20). Higher corneal esthesiometry threshold (lower corneal sensitivity) was correlated with shorter non-invasive tear film breakup time (Spearman’s rho =  − 0.361, p = 0.04) and increased fluorescein staining score (Spearman’s rho = 0.417, p = 0.02). Keratoplasty can induce persistent changes in the ocular surface and tear film, including: increased fluorescein staining, decreased tear film breakup time, decreased corneal sub-basal nerve plexus density, and reduced corneal sensitivity.