[Correlation of ocular surface changes with filtering bleb morphology after antiglaucoma surgery for primary angle-closure glaucoma].

Objective

To evaluate the ocular surface changes and their correlation with filtering bleb morphology after phacoemulsification cataract extraction with intraocular lens implantation (PEI) combined with trabeculectomy for primary angle-closure glaucoma (PACG).

Methods

A retrospective case-series study. PACG patients who underwent PEI combined with trabeculectomy between October 2021 and March 2023 were included. Preoperatively and at 3 and 6 months postoperatively, best corrected visual acuity (BCVA), intraocular pressure (IOP), surgical complications, 5-fluorouracil subconjunctival injection, and ocular surface data, including the noninvasive first tear film breakup time (NIF-BUT) and average tear film breakup time, tear meniscus height, tear film dynamic scattering index, Schirmer Ⅰ test, corneal staining score, meibomian gland function score, and ocular surface disease index questionnaire (OSDI), were recorded. At 6 months postoperatively, filtering blebs were graded according to the Indiana Bleb Appearance Grading Scale to explore the correlation between bleb morphology and ocular surface function.

Results

A total of 51 patients (51 eyes) were included, comprising 18 males (35.3%) and 33 females (64.7%), with 22 left eyes (43.1%) and 29 right eyes (56.9%). The mean age was 63.9±7.6 years, and the mean follow-up duration was 7.5±2.1 months. The BCVA values at baseline, 3 months, and 6 months postoperatively were 0.22 (0.1, 0.52), 0.15 (0.05, 0.4), and 0.15 (0.1, 0.22), respectively. At 6 months, the BCVA was significantly improved compared with baseline (P=0.004). The IOP at baseline, 3 months, and 6 months was 26.9 (18.6, 33.2) mmHg(1 mmHg=0.133kPa), 12.8 (11.0, 16.3) mmHg, and 12.9 (11.2, 14.5) mmHg, respectively, and was significantly lower at both 3 and 6 months than that at baseline (P<0.001). The complete success rates at 3 and 6 months were 98.0% and 96.1%, respectively, and the qualified success rates were both 100%. No statistically significant differences were found in the noninvasive average tear film breakup time, tear meniscus height, tear film dynamic scattering index, Schirmer Ⅰ test, or corneal staining score among preoperative and postoperative 3-month and 6-month data. The NIF-BUT values at baseline, 3 months, and 6 months were 7.46 (4.40, 11.47) s, 5.22 (3.50, 8.15) s, and 7.84 (5.93, 11.24) s, respectively; the NIF-BUT at 3 months was significantly lower than that at 6 months (P=0.004). The OSDI scores at baseline, 3 months, and 6 months were 30.56 (25.00, 38.89), 23.47 (17.56, 32.88), and 25.00 (17.62, 30.56), respectively; the score at 3 months was significantly lower than that at baseline (P=0.016). The meibomian gland scores at baseline, 3 months, and 6 months were 3 (2, 3), 3 (2, 4), and 3 (3, 4), respectively; the score at 6 months was significantly higher than that at baseline (P=0.003). At 6 months postoperatively, except for the positive correlations of the corneal staining score with bleb vascularity and the number of 5-fluorouracil injections (r=0.405, P=0.003; r=0.401, P=0.003), no significant correlations were found between the bleb grading or number of 5-fluorouracil injections and the postoperative visual acuity, IOP, other ocular surface parameters, or OSDI scores.

Conclusions

The PACG patients can achieve good visual improvement and high surgical success rates after PEI with trabeculectomy. A transient decline in the objective ocular surface parameter NIF-BUT and the subjective OSDI score can be observed at 3 months postoperatively, with recovery by 6 months. The meibomian gland function gradually deteriorates over time. The corneal staining can be positively correlated with the postoperative bleb vascularity and the number of 5-fluorouracil injections.