[Correlation of ocular surface changes with filtering bleb morphology after antiglaucoma surgery for primary...

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.