Upper Eyelid Meibomian Gland Dysfunction is a Risk Factor for Dry Eye Symptoms Following Cataract Surgery in the Early Phase

Figures & data

Table 1 Comparison of Parameters in All the Included Eyes Measured Before and 1 Month After Cataract Surgery

Parameter	Before Surgery		After Surgery		P-value (Before vs After Surgery)
	Mean ± SD	95% Confidence Interval	Mean ± SD	95% Confidence Interval
NIBUT (s)	9.98 ± 5.53	8.76 to 11.20	7.57 ± 4.69	6.55 to 8.58	0.0010
Schirmer test (mm)	9.04 ± 4.54	8.03 to 10.01	10.59 ± 7.29	9.01 to 12.16	0.10
Fluorescein stein score (0–9)^Citation11	0.28 ± 0.59	0.15 to 0.41	0.64 ± 0.92	0.45 to 0.85	0.022
OSDI score	0.0 ± 0.0	0.0 to 0.0	1.90 ± 4.01	1.03 to 2.77	< 0.001
Dry eye grade by DR-1α (0–5)	2.50 ± 0.53	2.39 to 2.62	2.74 ± 0.48	2.64 to 2.85	0.003
TMH (mm)	0.27 ± 0.16	0.23 to 0.30	0.27 ± 0.14	0.24 to 0.30	0.91
Vascularity of lid margin: telangiectasia (0, no; 1, yes)	0.21 ± 0.42	0.11 to 0.26	0.38 ± 0.49	0.27 to 0.48	0.036
Mucocutaneous junction: anteroplacement or retroplacement (0, no; 1, yes)	0.49 ± 0.50	0.38 to 0.60	0.48 ± 0.50	0.37 to 0.58	0.98
Irregular lid margin (0, no; 1, yes)	0.06 ± 0.24	0.01 to 0.11	0.18 ± 0.39	0.10 to 0.27	0.031
Total lid margin abnormality (0, no; 1, yes)^Citation12	0.59 ± 0.50	0.48 to 0.69	0.73± 0.45	0.64 to 0.83	0.051
MG orifice obstruction (0, no; 1, yes)	0.66 ± 0.47	0.56 to 0.76	0.74 ± 0.46	0.65 to 0.84	0.30
Meibum expressibility decrease (0, no; 1, yes)	0.80 ± 0.40	0.72 to 0.89	0.73 ± 0.45	0.64 to 0.83	0.33
Total MG obstruction (0, no; 1, yes)^Citation12	0.62 ± 0.49	0.52 to 0.73	0.61 ± 0.49	0.50 to 0.72	0.49
Upper eyelid MG loss area (%)	73.9 ± 4.3	73.0 to 74.9	75.4 ± 3.9	74.6 to 76.3	< 0.001
Lower eyelid MG loss area (%)	57.7 ± 11.1	55.3 to 60.1	60.6 ± 8.6	58.8 to 62.5	0.002
Conjunctiva redness in nasal limbs (0–4)	1.20 ± 0.51	1.10 to 1.30	1.21 ± 0.46	1.12 to 1.93	0.38
Conjunctiva redness in temporal limbs (0–4)	1.25 ± 0.40	1.17 to 1.33	1.36 ± 0.36	1.29 to 1.44	0.021

Notes: All P-values were calculated using a generalized estimating equation model.

Abbreviations: MG, meibomian gland; MGD, meibomian gland dysfunction; NIBUT, non-invasive tear break-up time; OSDI, ocular surface disease index; SD, standard deviation; TMH, tear meniscus height.

Figure 1 Representative measurements of upper and lower eyelid MG loss area (%). Representative measurements of upper eyelid MG by meibography on Keratograph 5M before cataract surgery (A); digitized image from A (B); meibography image after cataract surgery (C); digitized image from C (D). Representative measurements for lower eyelid MG by meibography on Keratograph 5M before cataract surgery (E); digitized images from E (F); meibography after cataract surgery (G); digitized image from G (H). Example of total analysis area (I) and detected MG area (J) used to compute the loss area (%).

Abbreviation: MG, meibomian gland.

Table 2 Comparison of the Background Parameters and the Parameters Before and 1 Month After Cataract Surgery in Patients with and without Cataract Surgery-Induced Subjective DE Symptom (OSDI > 0)

Label	With Cataract Surgery-Induced Subjective DE Symptom (21 Eyes) Mean ± SD		Without Cataract Surgery-Induced Subjective DE Symptom (61 Eyes) Mean ± SD		P-value (with vs Without Cataract Surgery-Induced Subjective DE Symptom)
Age (years)	76.30 ± 5.36		75.50 ± 4.67		0.40
Female (%)/Males	15 (71.4%)/6		22 (36.1%)/39		0.002
Diabetes mellitus (%)	1 (4.8%)		17 (27.9%)		0.06
Hypertension (%)	7 (33.3%)		31 (50.8%)		0.41
Duration of surgery (min)	5.90 ± 0.70		6.11 ± 0.95		0.29
	Before Surgery	After Surgery	Before Surgery	After Surgery	Before Surgery	After Surgery
NIBUT (s)	10.70 ± 5.37	7.11 ± 4.22	9.73 ± 5.61	7.72 ± 4.86	0.46	0.59
Schirmer test (mm)	8.76 ± 4.54	11.67 ± 7.73	9.15 ± 4.58	10.21 ± 7.16	0.91	0.39
Fluorescein stein score (0–9)^Citation11	0.24 ± 0.62	0.76 ± 0.89	0.30 ± 0.59	0.61 ± 0.94	0.72	0.31
OSDI score	0.0 ± 0.0	7.42 ± 4.71	0.0 ± 0.0	0.0 ± 0.0	1	< 0.001
Dry eye grade by DR-1α (0–5)	2.67 ± 0.64	2.79 ± 0.49	2.44 ± 0.47	2.73 ± 2.53	0.23	0.17
TMH (mm)	0.26 ± 0.14	0.22 ± 0.09	0.27 ± 0.17	0.29 to 0.15	0.98	0.016
Vascularity of lid margin: telangiectasia (0, no; 1, yes)	0.24 ± 0.44	0.43 ± 0.51	0.21 ± 0.41	0.36 ± 0.48	0.75	0.53
Mucocutaneous junction: anteroplacement or retroplacement (0, no; 1, yes)	0.43 ± 0.51	0.48 ± 0.52	0.51 ± 0.50	0.49 ±0.50	0.57	0.88
Irregular lid margin (0, no; 1, yes)	0.10 ± 0.30	0.19 ± 0.40	0.05 ± 0.22	0.18 ±0.39	0.58	0.83
Total lid margin abnormality (0, no; 1, yes)^Citation12	0.52 ± 0.51	0.76 ± 0.43	0.66 ± 0.48	0.72 ± 0.45	0.59	0.39
MG orifice obstruction (0, no; 1, yes)	0.52 ± 0.51	0.76 ± 0.44	0.70 ± 0.46	0.72 ± 0.45	0.25	0.89
Meibum expressibility decrease (0, no; 1, yes)	0.90 ± 0.30	0.90 ± 0.30	0.77 ± 0.42	0.67 ± 0.47	0.15	0.028
Total MG obstruction (0, no; 1, yes)^Citation12	0.52 ± 0.51	0.71 ± 0.46	0.66 ± 0.48	0.57 ± 0.50	0.43	0.51
Upper eyelid MG loss area (%)	75.5 ± 4.1	76.8 ± 4.2	72.7 ± 3.6	74.9 ± 3.8	0.006	0.67
Lower eyelid MG loss area (%)	57.1 ± 11.0	61.5 ± 5.4	57.9 ± 11.2	60.4 ± 9.5	0.70	0.45
Conjunctival redness in nasal limbs	1.26 ± 0.39	1.31 ± 0.53	1.18 ± 0.54	1.19 ± 0.45	0.13	0.90
Conjunctival redness in the temporal limbs	1.29 ± 0.35	1.44 ± 0.32	1.25 ± 0.41	1.35 ± 0.37	0.23	0.91

Notes: All P-values were calculated using a generalized estimating equation model.

Abbreviations: MG, meibomian gland; MGD, meibomian gland dysfunction; NIBUT, non-invasive tear break-up time; OSDI, ocular surface disease index; SD, standard deviation; TMH, tear meniscus height.

Figure 2 Baseline and preoperative ocular parameters in eyes with or without cataract surgery-induced DE symptoms. The representative baseline and preoperative ocular parameters, female ratio (A), upper eyelid MG loss area (%) (B), lower eyelid MG loss area (%) (C), are presented. The horizontal lines in the box and whisker plots represent the median values, and the bottom and top of the boxes represent the lower and upper quartiles, respectively. The x represents the mean and the bars represent the minimum and maximum values within 1.5 times the lower and upper quartiles. (**P < 0.01, generalized estimating equation models).

Abbreviations: MG, meibomian gland; TMH, tear meniscus height; OSDI, ocular surface disease index.

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