Abstract
Purpose To investigate the effect of preoperative treatment and postoperative enhanced anti-inflammatory treatment on alleviating meibomian gland dysfunction (MGD) and dry eye induced by cataract surgery. Design Prospective, randomized clinical trial. Methods A total of 120 cataract patients with moderate obstructive-MGD were enrolled and randomized with 60:30:30 number of patients in cohorts I, II, and III, respectively: Cohort I: routine postoperative anti-inflammatory treatment; Cohort II: preoperative treatment (warming compress, lid hygiene, and anti-inflammatory treatment) and routine postoperative anti-inflammatory treatment; Cohort III: enhanced postoperative anti-inflammatory treatment. Main Outcomes Measures All participants were examined preoperatively and postoperatively for ocular symptom score (OSS), noninvasive keratographic tear break-up time (NIKBUT), corneal fluorescein staining, Schirmer I test, lid margin, meibum quality and expressibility, and meibomian gland dropout. Results Ocular surface disorders and MGD showed aggravated status at 1 month postoperatively in Cohort I and Cohort III, and the aggravated MGD resolved by 3 months postoperatively. At 1 month postoperatively, Cohort II and Cohort III presented high NIKBUT and low OSS, lid margin, and meibum quality and expressibility (Cohort II vs Cohort I: all P<0.001, respectively; Cohort III vs Cohort I: P=0.011, P=0.024, P=0.046, P=0.045, and P=0.012, respectively). Additionally, Cohort II had better outcomes of lid margin and meibum quality and expressibility than Cohort III at 1 month postoperatively (P=0.031, P=0.026, and P<0.001, respectively). At 3 months postoperatively, Cohort II presented a significantly higher NIKBUT than Cohort I and Cohort III (P<0.001 and P=0.001, respectively). Conclusion Preoperative management of MGD is effective and optimal in alleviating obstructive-MGD and dry eye induced by cataract surgery.
Highlights
Dry eye, which has been attributed primarily to the tear film dysfunction, is one of the most frequent complaints after cataract surgery; the deterioration of the tear film layer after cataract surgery is multifactorial [1,2,3,4,5]
The development and aggravation of obstructive meibomian gland dysfunction (MGD) and tear film dyshomeostasis were revealed at 1 month postoperatively, and the meibomian glands (MGs) parameters returned to the preoperative level by 3 months postoperatively in all cohorts, which indicated that cataract surgery may not aggravate moderate obstructive MGD under routine postoperative management in long-term follow-up
The most notable finding was that the preoperative management and postoperative enhanced anti-inflammatory treatment can lead to significantly better outcomes of ocular surface and MGs than routine postoperative treatment
Summary
Dry eye, which has been attributed primarily to the tear film dysfunction, is one of the most frequent complaints after cataract surgery; the deterioration of the tear film layer after cataract surgery is multifactorial [1,2,3,4,5]. Researchers have found the prevalence of meibomian gland dysfunction (MGD) after cataract surgery and explored the relationship of them; the correlation between them was not fully consistent. Han et al suggested that cataract surgery seems to alter the function of the meibomian glands (MGs) without accompanying structural changes; the ocular symptom scores remained unrecovered at 3 months postoperatively [5]. Park et al revealed that MGD was aggravated accompanying MGs structural changes after cataract surgery [7]. Suggested that the extent to which the MGD grade was aggravated following cataract surgery differed based on preoperative MGD grade [8]. The exact mechanism by which cataract surgery impairs MGs function remains unknown
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