| Objective:To study the influence of meibomian gland physical therapy on the ocular surface after cataract surgery,evaluate the necessityand effectiveness of meibomian gland physical therapy before surgery for cataract patients with meibomian gland dysfunction,and explore and determine the best time for cataract surgery after meibomian physiotherapy.Methods:A prospective case-control study was conducted.A total of 100 eyes of 50 patients with MGD treated in our hospital from December 2020 were selected for one ultrasonic atomization combined with meibomian gland massage,and the thickness of lipid layer was measured by LipView ocular surface interferometer for 14 consecutive days.Then 38 eyes of 38 age-related cataract patients with MGD were selected from January 2021 to May 2021 in our hospital,two groups were randomly divided into two groups:group A（20 eyes）received cataract surgery on average 4 days after ultrasonic atomization combined with meibomian gland massage,and group B（18 eyes）received cataract surgery on average 9 days after ultrasonic atomization combined with meibomian gland massage.Thebreak-up time,corneal fluorescein staining scores,lipid layer thickness,Schirmer I test,ocular surface disease index,meibomian gland secretion eduction ability score,meibomian gland secretions score of each group before phacoemulsification and 1,2,3 and 4 weeks after phacoemulsification were examined and compared.To observe and analyze the efficacy of ultrasonic atomization combined with meibomian gland massage on MGD patients after cataract surgery,and to explore the time required for meibomian gland physical therapy to improve MGD,which can be used as a guide for cataract surgery timing selection after physical therapy for cataract patients with MGD.The experimental data and drawing were processed by SPSS 21.0 software package and GraphPad Prism version 8.0.2 software package.Enumeration data were expressed inrate（%）,using χ2 test;measurement data were expressed as mean±standard deviation（x±s）;all measurement data in this study met normal distribution;the differences between the two groups at multiple time points were Repeated measures analysis of variance was used for the comparison.If the data covariance matrix satisfies the sphericity test,the sphericity test is used,and if it fails,the Greenhouse-Geisser correction is used;the comparison between the two groups at the same time point uses the independent sample t test;The comparison of different time points in the same group was performed by paired sample t test;the test level was set at α=0.05,and the difference was considered statistically significant when P<0.05.Results:1.After the meibomian gland physical therapy for MGD patients,the lipid layer thickness reached the peak value on day 4 and day 9,respectively,and the ocular surface state was slightly better at this time;2.There were statistically significant differences in BUT between the two groups at different measurement times(F时间=123.245,P时间<0.001;F时间×组别=0.769,P时间×组别=0.489;F组别=5.284,P组别=0.027).BUT results of group A at 1wk,2wK,3wk and 4wk were significantly better than those of group B,and the differences were statistically significant（P<0.05）.Compared with pre-operation,BUT was decreased at all postoperative time points in both groups,with statistical significance（P<0.05）;3.There was significant difference in CFS score between the two groups at different measurement times(F时间=18.545,P时间<0.001;F时间×组别=1.640,P时间×组别=0.199;F组别=6.899,P组别=0.013).The CFS scores of group A at 1 wk,2 wk,3 wk and 4 wk after operation were all lower than those of group B,and the difference was statistically significant（P<0.05）.Compared withpre-operation,CFS scores of the two groups increased at each post-operation time point,with statistically significant differences（P<0.05）.4.There was no significant difference in LLT between the two groups before and after operation(F时间=1.340,P时间=0.258;F时间×组别=0.420,P时间×组别=0.779;F组别=0.145,P组别=0.705).And no significant difference in LLT at 1 week,2 weeks,3 weeks and 4 weeks between two groups after operation（P>0.05）.Compared with the preoperative level,LLT at all postoperative time points was decreased in both groups,and the difference was not statistically significant.5.There were statistically significant differences in SIt time and interaction between the two groups before and after surgery,but there were no statistically significant differences between the two groups(F时间=13.167,P时间<0.001;F时间×组别=17.635,P时间×组别<0.001;F组别=3.944,P组别=0.055).At 1wk,2wk,3wK and 4wk,the tear length in SIt test in group A was higher than that in group B,and the differences were statistically significant（P<0.05）.Compared with pre-operation,the tear length at each time point in the SIt test was reduced in both groups,and the decrease was more significant in group B.The difference between the SIt results at each time point after operation and pre-operation was statistically significant in group B（P<0.05）.6.The OSDI scores of the two groups at different measuring time were statistically significant(F时间=347.846,P时间<0.001;F时间×组别=17.635,P时间×组别<0.001;F组别=13.362,P组别=0.001).The OSDI scores of group A at 1wK,2WK,3WK and 4wK were better than those of group B,and the differences were statistically significant（P<0.05）.Compared with before surgery,OSDI scale scores of both groups increased at each time point after surgery,and the difference was statistically significant（P<0.05）.7.There were statistically significant differences in the discharge capacity of meibomian gland secretions between the two groups at different measuring times(F时间=41.926,P时间<0.001;F时间×组别=2.213,P时间×组别=0.070;F组别=11.849,P组别=0.001).The discharge ability scores of meibomian gland secretions in group A at 1wk,2wk,3wk and 4wkwere higher than those in group B,and the differences were statistically significant（P<0.05）.Compared with pre-operation,the discharge capacity of meibomian gland secretions was decreased at all postoperative time points in both groups,with statistical significance（P<0.05）.8.There was no significant difference in meibomian secretions between the two groups at different measuring time（P>0.05）,there was no significant difference in meibomian gland secretion at 1wk,2wk,3wk and 4wk after operation between the two groups（P>0.05）.Conclusion:1.Phacoemulsification can destroy the function and ocular surface state of meibomian gland in MGD patients,and preoperative physical therapy of meibomian gland can significantly improve the ocular surface status of MGD patients after cataract surgery.Meibomian physiotherapy is effective and necessary for cataract patients with MGD before surgery.2.The cataract patients with MGD underwent surgery on the 4th day after physical therapy of meibomian gland.The postoperative symptoms of dry eye discomfort were reduced,the damage of corneal epithelium was minor,the stability of tearfilm was better,the amount of tear secretion was less decreased,and the damage degree of morphology and function of meibomian gland was reduced,ocular surface can achieve a better state,dry eye symptoms and the impact on the function appears lighter. |
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