Clinical Analysis On Changes Of Ocular Surface And Meibomian Glang After Keratoplasty

SUBJECT To explore the effect of keratoplasty on the ocular surface and the meibomian gland.METHODS This study was a prospectively self-controlled clinical trial which included a total of 33 patients(33 eyes)who underwent noninfectious keratoplasty in our hospital from July 2017 to June 2019,including 23 cases of penetrating keratoplasty(PK),and 10 cases of deep anterior lamellar keratoplasty(DALK).The parameters including Ocular Surface Disease Index(OSDI),intraocular pressure(IOP),tear break-up time(TBUT),corneal fluorescein staining(FL),Schirmer I test(SIT)were evaluated.The meibomian gland yielding secretion scores(MGYSS)were assessed using meibomian gland evaluator(MGE).The lipid layer thickness(LLT),partial blink rate(PBR)and meibomian gland loss(MGL)were measured with LipiView?.All results were recorded preoperatively and 1 day,1 week,1month,3months,6months postoperatively.RESULTS OSDI increased significantly at 1 day,1 week,1 month,3 months,and 6 months postoperatively(p <0.01);IOP increased at 1 day,1week,3 months postoperatively(p <0.01),and there was no statistical difference at 1 month(p = 0.087),6 months(p = 0.354)compared with baseline;TBUT decreased gradually at 1 day,1 week after surgery,and began to rebound at 1 month,3 months,6 months,all the results were statistically different compared with baseline(p <0.001);FL increasedsignificantly at 1 day and gradually decreased at 1 week,1 month,3months,and 6 months,all the results were statistically different compared with baseline(p <0.001);SIT increased at 1 day and gradually decreased at1 week,1 month,all the results were statistically different compared with baseline(p <0.001),and there was no statistical difference at 3 months(p =0.189)and 6 months(p = 0.460)from baseline;LLT increased significantly at 1 day,gradually decreased at 1 week,1 month,all the results were statistically different compared with baseline(p <0.001),and there was no statistical difference at 3 months(p = 0.060)and 6 months(p = 0.422)from baseline;PBR was not statistically different at 1 day,1 week,1 month,3months,6months compared with baseline(p> 0.05);MGYSS was not statistically different at 1 day(p = 0.636),1 week(p = 0.610)from baseline,but it gradually decreased at 1 month,3 months,6 months,and there was significant difference compared with baseline(p <0.001);MGL was not statistically different at 1 day(p = 0.913),1 week(p = 0.914),1 month(p =0.604)compared with baseline,but gradually increased at 3 months,6months from baseline,the difference was statistically significant(p<0.001).CONCLUSION Keratoplasty and postoperative medication may lead to instability of the tear film on the ocular surface,functional decline and structural changes of meibomian gland,exacerbating the occurrence of hyper-evaporative dry eye.Therefore,in order to improve the success rate of keratoplasty and reduce the impact of complications,the evaluation and intervention of the postoperative ocular surface and meibomian glands should not be ignored.