Dry Eye Disease in Patients with Functioning Filtering Blebs after Trabeculectomy

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Ocular Surface Disease

Background:

• Trabeculectomy is a common glaucoma surgery that creates filtering blebs.
• Filtering blebs can be associated with ocular surface complications, including dry eye disease (DED).
• Understanding the relationship between bleb morphology and DED is crucial for patient management.

Purpose of the Study:

• To investigate the prevalence of DED in patients with functioning filtering blebs post-trabeculectomy.
• To explore the association between filtering bleb morphology and ocular surface instability in these patients.
• To identify specific bleb characteristics linked to DED.

Main Methods:

• A cross-sectional, case-comparison study involving 70 glaucoma patients with functioning blebs and 35 controls.
• Ocular symptom questionnaires, meibomian gland evaluation, tear film break-up time (TFBUT), fluorescein corneal staining, and Schirmer's tear test were performed.
• Filtering bleb morphology was assessed using Wuerzburg bleb classification criteria.

Main Results:

• Patients with functioning blebs showed significantly higher corneal staining and lower TFBUT compared to controls.
• DED was diagnosed in 28% of patients with functioning blebs versus 17% in controls.
• Higher microcyst presence and bleb height were significantly correlated with increased corneal staining and DED.

Conclusions:

• Dry eye disease is a frequent complication in patients with functioning filtering blebs after trabeculectomy.
• Symptoms of dryness and watery eyes are common in DED patients with filtering blebs.
• Filtering bleb morphology, specifically microcysts and bleb height, is associated with ocular surface instability and DED.