Assessment of meibomian glands and tear film in post-refractive surgery patients

Abstract

IMPORTANCE: Corneal refractive surgery may impact meibomian gland and tear film in post-refractive surgery patients.

BACKGROUND: To compare ocular surface parameters between post-refractive surgery patients and normal controls.

DESIGN: Cross-sectional single centre study.

PARTICIPANTS: A total of 120 eyes of 120 subjects were divided into three groups: (i) 60 controls and 60 patients underwent corneal refractive surgery at least 12 months ago; (ii) 30 post-laser in-situ keratomileusis (LASIK) patients and (iii) 30 post-laser epithelial keratomileusis (LASEK)/photo-refractive keratectomy (PRK) patients.

METHODS: Tear meniscus height, non-invasive keratographic tear film break-up time and meibography were measured using the Keratograph® 5M. Fluorescein break-up time, ocular surface staining, examination of lid margins and meibomian glands, Schirmer's test and Ocular Surface Disease Index questionnaire were performed.

MAIN OUTCOME MEASURES: Ordinary logistic regression was performed to evaluate the impact of clinical variables including refractive surgery on the meiboscores.

RESULTS: In post-LASIK patients, ocular surface parameters including Ocular Surface Disease Index scores, fluorescein break-up time and staining scores, except Schirmer's scores, were significantly worse than those in controls (P < 0.050). Ocular surface staining scores in post-LASEK/PRK patients was higher than that in the controls (P = 0.001). In post-refractive surgery patients, grade of meibomian gland parameters and meiboscores were worse than those of controls (all P < 0.050). Histories of refractive surgery were associated with high meiboscore (β = 1.100, P = 0.043 for LASIK and β = 1.039, P = 0.042 for LASEK/PRK).

CONCLUSIONS AND RELEVANCE: Corneal refractive surgery may adversely affect the ocular surface, and a reduction of functional meibomian glands can contribute to chronic tear film dysfunction after corneal refractive surgery.