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

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.