- - -

Although Although 2 and with increased MG dropout at 1 month month 1 at dropout MG increased with and 3 After cataract surgery, an excellent postoperative postoperative excellent an surgery, cataract After DISCUSSION symptoms, DED by overshadowed be can outcome visual vision. blurred transiently and irritation ocular including the of alterations to attributed be can problems These phacoemulsification. during surface ocular transient, be to thought are alterations these of most signifi are symptoms persistent that showed al et Choi obstruc orifice MG and TBUT low with associated cantly scores tion persistent of risk at patients identify To surgery. after ear allow thereby (and preoperatively symptoms DED regression performed investigators the treatment), lier

- meibomian gland dropout at 1 month after surgery. meibomian gland dropout at 1 month after surgery. meibomian gland dysfunction (MGD) parameters with persistent DED symptoms DED symptoms with persistent parameters meibomian gland dysfunction (MGD) for persistent phacoemulsification. The following appeared to be risk factors after Surface Disease Index score, postoperative DED symptoms: a high preoperative Ocular increased orifice obstruction scores, and low tear breakup time and meibomian gland Researchers evaluated the association of perioperative dry eye disease (DED) and disease (DED) and dry eye perioperative Researchers evaluated the association of 

s as risk parameters parameters and, in particular, MGD Investigators identified DED WHY IT MATTERS findings underscore the cataract surgery. These for persistent DED symptoms after factors and MGD before surgery and of following up importance of diagnosing and treating DED should optimize patient further treatment postoperatively as needed. Effective therapy with visual acuity, and satisfaction after cataract surgery. comfort, STUDY IN BRIEF - - Parameters of meibomian gland dysfunction predict persistent postoperative postoperative persistent gland dysfunction predict Parameters of meibomian presenting for of patients percentage a large and are prevalent in eye symptoms dry cataract surgery. | OCTOBER 2018

1

Statistically significant risk factors for factors risk significant Statistically Choi and colleagues evaluated perioperative dry eyedry perioperative evaluated colleagues and Choi after surgery, and increased MG dropout. MG increased and surgery, after these that concluded colleagues and Choi postopera at and baseline at parameters predicting in important were 1 month tive after persist would that symptomsDED surgery. cataract evaluated and recorded at baseline and at and baseline at recorded and evaluated postoperative.months 3 and 1 symptoms DED postoperative persistent TBUT low score, OSDI baseline high were month 1 scores obstruction orifice MG and tears. Parameters including lipid layer thick layer lipid including Parameters tears. tear dropout, (MG) gland meibomian ness, score,staining Oxford (TBUT), time breakup quality,meibum abnormality, margin lid obstruction,orifice expressability, meibum IndexDisease Surface Ocular stage, MGD wereresult test Schirmer and score, (OSDI) disease (DED) and meibomian gland dysfunction (MGD)dysfunction gland meibomian and (DED) disease symptomspersistent with association their and parameters studyThe implantation. IOL with phacoemulsification after uncom underwent who patients 116 of eyes 116 included ocularof history no had who and surgery cataract plicated artificialthan other drops eye topical of use or comorbidity PERSISTENT DRY EYE SYMPTOMS AFTER CATARACT SURGERY PERSISTENT DRY EYE SYMPTOMS AFTER CATARACT SURGERY Choi YJ, Park SY, Jun I, et al ABSTRACT SUMMARY PERIOPERATIVE OCULAR PARAMETERS ASSOCIATED WITH ASSOCIATED WITH PERIOPERATIVE OCULAR PARAMETERS CATARACT SURGERY PATIENTS SURGERY CATARACT DRY EYE DISEASE, AND UNHAPPY UNHAPPY AND DISEASE, EYE DRY MEIBOMIAN GLAND DYSFUNCTION, DYSFUNCTION, GLAND MEIBOMIAN BY STEVEN L. MASKIN, MD; AND ERIN L. GREENBERG, MD GREENBERG, MD BY STEVEN L. MASKIN, MD; AND ERIN L. CATARACT & REFRACTIVE SURGERY TODAY

18 s THE LITERATURE - - - ) 8 ) 8 < .05).< P (Adapted from Maskin and Testa. , with resultant truncated short gland secondary to , with resultant truncated short gland secondary to (Adapted from Maskin and Testa. , with resultant whole-gland atrophy secondary to gland , with resultant whole-gland atrophy secondary to gland complete proximal obstruction complete distal obstruction these risk factors should be identified preoperatively and and preoperatively identified be should factors risk these appro and timely of initiation allow to closely monitored to appear particularly parameters MGD treatment. priate postopera persistent predicting in part prominent a play symptoms. tive Figure 1. Proximal, fixed, unyielding MG obstruction from periductal fibroses, described periductal fibroses, described Figure 1. Proximal, fixed, unyielding MG obstruction from as gland atrophy proximal to obstruction. Figure 2. Distal, fixed, unyielding MG obstruction from periductal fibroses, described as atrophy proximal to obstruction. a lower mean lipid layer thickness (58.5 ±19.58 nm) wasnm) ±19.58 thickness(58.5 layer lipid mean lower a (moder 8 than greater scores SPEED with patients in found patientsof 52% Additionally, symptoms). DED severe to ate werepatients MGD of 50% MGD, have to found were atrophy. MG had patients all of 56% and asymptomatic, symptoms,age, with significantly correlated function MG ( atrophy MG and thickness, layer lipid a

4 - < .05). In contrast,In .05). < P | OCTOBER 2018 5

Meanwhile, 56% of all patients showed meibomian gland of all patients showed meibomian gland Meanwhile, 56% structure that preoperative testing of gland suggesting atrophy, patients. and function for obstructive MGD is needed in all meibomian gland dysfunction (MGD) and subjective dry and subjective dry meibomian gland dysfunction (MGD) cataract surgery. patients presenting for eye symptoms in of MGD in this patient a 52% incidence Researchers found asymptomatic. MGD were those with and half of population, Investigators prospectively evaluated the incidence of Investigators prospectively evaluated the incidence of 

s MGD and symptoms of dry eye obstructive link between The disease after phacoemulsification is well established. Through the the Through established. is well disease after phacoemulsification management of patients with MGD, preoperative identification and improve who are asymptomatic, ophthalmologists can including those visual outcomes, comfort, and satisfaction. postoperative patients’ WHY IT MATTERS STUDY IN BRIEF Statistically significantly higher mean lipid layer thicknesslayer lipid mean higher significantly Statistically Cochener and colleagues investigated the incidence the investigated colleagues and Cochener high OSDI score, and increased MG dropout were highly highly were dropout MG increased and score, OSDI high phaco after symptoms DED persistent with associated with patients that suggest findings These emulsification. analysis on baseline parameters and found that female female that found and parameters baseline on analysis expressability, meibum of score high a age, younger sex, (77.5 ±19.48 nm) was found to correlate with a SPEED scoreSPEED a with correlate to found was nm) ±19.48 (77.5 symptoms, DED (mild 8 than less of LipiScan Dynamic Meibomian Imager (both from Johnson from (both Imager Meibomian Dynamic LipiScan performed was examination Slit-lamp Vision). Johnson & Meibomian the used investigators and TBUT, evaluate to determine to Vision) Johnson & (Johnson Evaluator Gland presence secretionsand MG of quantity and quality the MGD. of of MGD and evaluated subjective DED symptoms in symptoms DED subjective evaluated and MGD of series case prospective This candidates. surgery cataract completed whom of all patients, 180 of eyes 342 included (SPEED) Dryness Eye of Evaluation Patient Standard the thickness, layer lipid their Additionally, questionnaire. measured were structure gland and rate, blink partial and Interferometer Surface Ocular II LipiView the using TIME OF CATARACT SURGERY SURGERY TIME OF CATARACT Omiel L Cochener B, Cassan A, ABSTRACT SUMMARY PREVALENCE OF MEIBOMIAN GLAND DYSFUNCTION AT THE GLAND DYSFUNCTION AT THE PREVALENCE OF MEIBOMIAN CATARACT & REFRACTIVE SURGERY TODAY

20 s THE LITERATURE - Invest . 2003;1(3):107-126. Ocul Surf . 2000;41(13):4117-4123. . New York: Plenum Press; 1997:27-35. EDWARD MANCHE, MD Advances in Corneal Research: Selected Transections of theAdvances in Corneal Research: . 2007;33(9):1631-1635. . 2012;53(14):605. Invest Ophthalmol Vis Sci Ophthalmology Resident, University of South Ophthalmology Resident, University of South [email protected] Financial disclosure: None Dry Eye and Cornea Treatment Center, Tampa, [email protected] Financial disclosure: Holds patents on methods Director of Cornea and Refractive Surgery, Surgery, Director of Cornea and Refractive Stanford University Professor of Ophthalmology, [email protected] Financial disclosure: None Florida, Tampa Florida and devices for intraductal meibomian gland diagnosis and treatment Stanford Laser Eye Center, California Stanford Laser Eye Center, School of Medicine, California        9. Maskin SL. Meibomian gland probing findings suggest fibrotic obstruction gland probing findings suggest fibrotic 9. Maskin SL. Meibomian meibomian gland dysfunction (O-MGD). is a major cause of obstructive Ophthalmol Vis Sci pathogenic marginal dimples: clinical indicants of reactive 10. Cher I. Meibomian processes. In: Lass J, ed. n n n STEVEN L. MASKIN, MD n n n World Congress on the Cornea. IV a clinical scheme for descrip 11. Foulks GN, Bron AJ. Meibomian gland dysfunction: tion, diagnosis, classification, and grading. and visual impact of tear break-up12. Tutt R, Bradley A, Begley C, Thibos LN. Optical in human eyes. the optical quality of the human eye.13. Montés-Micó R. Role of the tear film in J Cataract Refract Surg SECTION EDITOR n n n n ERIN L. GREENBERG, MD - - - Br J Ocul n It alsoIt . 2011;52(4):1922- . 2007;26(9 suppl . 2018;37(6):734-739. 12,13 Cornea Cornea . 2018;44(2):144-148. Invest Ophthalmol Vis Sci . 1998;105(8):1485-1488. which helps prevent post prevent helps which 8 J Cataract Refract Surg . 1998;17(1):38-56. Ophthalmology Cornea . 2018;102(1):59-68. The only way to provide unequivocalprovide to way only The . 2007;5(2):75-92. Classification Subcommittee of the International Dry Eye WorkShop (2007). Surf 7. Nichols KK, Foulks GN, Bron AJ, et al. The international workshop on meibomian gland dysfunction: executive summary. 1929. 8. Maskin SL, Testa WR. Growth of meibomian gland tissue after intraductal meibo mian gland probing in patients with obstructive meibomian gland dysfunction. Ophthalmol can promote greater comfort, bettercomfort, greater promote can satisfactionimproved and acuity, visual surgery. cataract after patients for 1. Choi YJ, Park SY, Jun I, et al. Perioperative ocular parameters associated with persistent dry eye symptoms after cataract surgery. 2. Li XM, Hu L, Hu J, Wang W. Investigation of dry eye disease and analysis of the pathogenic factors in patients after cataract surgery. 1):S16-20. 3. Shimazaki J, Goto E, Ono M, et al. Meibomian gland dysfunction in patients with Sjögren syndrome. 4. Pflugfelder SC, Tseng SC, Sanabria O, et al. Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation. 5. Cochener B, Cassan A, Omiel L. Prevalence of meibomian gland dysfunction at the time of cataract surgery. 6. The definition and classification of dry eye disease: report of the Definition and positive physical proof of a patenta of proof physical positive proximal without tract outflow meibum sur cataract before obstruction distal or preoperatively MG the probe to is gery restoresalso Probing 2). and 1 (Figures function, MG tearto secondary symptoms operative aberrations,higher-order instability, film quality. image degraded and obstructionprogressive prevent helps probingMG Further, atrophy. MG from - - - - - , this type this , | OCTOBER 2018

—that remains inremains —that 9-11 because many glandsmany because 8 As this study demonstrated,study this As 2 and it is the most common causecommon most the is it and 6,7 MG expression and imaging willimaging and expression MG MGD is one of the most frequentlymost the of one is MGD expressible meibum from the glandthe from meibum expressible 1).(Figure tion proximally or deep to at leastat to deep or proximally tion representto acinus—thought one fibroses periductal Calledorifice. the with communication obstruction proximal complete intactby characterized is blockage of performing gland expression to evalu to expression gland performing toimaging using and function MG ate structure. MG assess obstruc MG of cases all capture not however, tion, obstruc unyielding fixed, have MGD exists in the majority of patientsof majority the in exists MGD andsurgery, cataract for presenting Theseasymptomatic. often are they tocolleagues and Cochener led findings toapproach proactive a recommend including MGD, obstructive diagnosing diagnosed conditions in clinical prac clinical in conditions diagnosed tice, linkthe described has Research DED. of phacoemulsifica and DED between ofmajority a that shown has and tion cataractafter DED develop patients surgery. DISCUSSION CATARACT & REFRACTIVE SURGERY TODAY

22 s THE LITERATURE