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Meibomian Gland Morphology Among Patients Presenting for Refractive Surgery Evaluation

Authors Brooks CC, Gupta PK

Received 19 November 2020

Accepted for publication 5 January 2021

Published 27 January 2021 Volume 2021:15 Pages 315—321


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Scott Fraser

Cassandra C Brooks, Preeya K Gupta

Department of Ophthalmology, Duke University Eye Center, Durham, NC, USA

Correspondence: Preeya K Gupta
Duke University Eye Center at Page Road, 4709 Creekstone Drive, Suite 100, Durham, NC 27703, USA

Purpose: To report the prevalence of meibomian gland atrophy and gland tortuosity in patients presenting for refractive surgery evaluation.
Methods: Cross-sectional study of consecutive patients presenting for refractive surgery evaluation at the Duke Eye Center from December 2018 through January 2020. All patients underwent clinical examination and meibography imaging (Lippiview II, Johnson and Johnson Vision, CA) of the lower eyelids bilaterally. Images were graded by a masked rater using a previously validated 5-point meiboscale (0– 4) for gland atrophy and 3-point scale for gland tortuosity (0– 2). Lipid layer thickness and partial blinks were also recorded.
Results: One hundred and twenty patients (49 male) aged 21 to 62 years (mean 35.2 ± 9.2 years) were reviewed. The mean meiboscale was 1.1 ± 1.0 and the mean tortuosity score was 1.0 ± 0.7. Among all patients, 72.5% (n = 87) had any evidence of meibomian gland atrophy (meiboscale > 0) and 69.2% (n = 83) had any evidence of meibomian gland tortuosity (tortuosity grade ≥ 1). The majority of patients (n = 52) with gland atrophy had mild gland atrophy (meiboscale = 1). The mean meiboscale was 0.89 ± 0.79 and 1.38 ± 1.07 for those < 35 years and >/= 35 years old, respectively (p = 0.01). There was a moderate positive relationship between meiboscale and tortuosity (Spearman’s rho 0.3829, p < 0.001).
Conclusion: Meibomian gland atrophy is a common occurrence in patients presenting for refractive surgery evaluation. Clinicians should consider incorporating meibography as part of refractive surgery evaluation, and proactively treat meibomian gland disease given the known association between meibomian gland dysfunction, dry eye disease, and the potential for suboptimal post-operative outcomes.

Keywords: dry eye disease, meibomian gland, refractive surgery, pre-operative evaluation

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