Skip to main content
SpringerLink
Log in

Meibomian gland loss due to trabeculectomy

  • Clinical Investigation
  • Published:
Japanese Journal of Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate meibomian gland loss after trabeculectomy with mitomycin C (MMC).

Methods

This cross-sectional observational case study involved 55 eyes in 39 patients who had undergone trabeculectomy with MMC administered to the upper area of the eye. We used a mobile pen-shaped noncontact meibography system to access the morphology and determine loss of the meibomian glands. Meibomian gland loss was scored (meiboscore) from grade 0 (no loss of the meibomian glands) through grade 3 (loss of more than two-thirds of the total area) in the bleb-contacting and bleb-noncontacting upper eyelid areas in the primary position and in the lower eyelid. The tear film breakup time (BUT) was also measured.

Results

The median duration from trabeculectomy to examination was 7.4 years (interquartile range 3.1–14.2). The meiboscores of the bleb-contacting upper eyelid areas were significantly higher than those for the bleb-noncontacting upper eyelid areas (P < 0.001). The meiboscores for both the bleb-contacting and the bleb-noncontacting upper eyelid areas were significantly higher when the bleb was avascular (P = 0.011 and P = 0.008, respectively). The meiboscores of the bleb-contacting and bleb-noncontacting upper eyelid areas showed a significant negative correlation with the BUT (r = −0.330, P = 0.014 and r = −0.296, P = 0.028, respectively).

Conclusion

Blebs that occur after trabeculectomy with MMC may be the cause of meibomian gland loss, particularly when the bleb is avascular. The presence of an avascular bleb warrants extra vigilance for decreased meibomian gland secretions because this decrease can lead to tear dysfunction and ocular surface damage, including bleb-wall damage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kitazawa Y, Kawase K, Matsushita H, Minobe M. Trabeculectomy with mitomycin: a comparative study with fluorouracil. Arch Ophthalmol. 1991;109:1693–8.

    Article  CAS  PubMed  Google Scholar 

  2. Belyea DA, Dan JA, Stamper RL, Lieberman MF, Spencer WH. Late onset of sequential multifocal bleb leaks after glaucoma filtration surgery with 5-fluorouracil and mitomycin C. Am J Ophthalmol. 1997;124:40–5.

    CAS  PubMed  Google Scholar 

  3. Li J, Pang L. Influence on tear film of postoperative 5-fluourouracil and intraoperative mitomycin C in glaucoma filtration surgery [in Chinese]. Zhonghua Yan Ke Za Zhi. 2001;37:43–7.

    CAS  PubMed  Google Scholar 

  4. Sagara H, Iida T, Suzuki K, Fujiwara T, Koizumi H, Yago K. Sodium hyaluronate eye drops prevent late-onset bleb leakage after trabeculectomy with mitomycin C. Eye. 2008;22:507–14.

    Article  CAS  PubMed  Google Scholar 

  5. Lee SY, Wong TT, Chua J, Boo C, Soh YF, Tong L. Effect of chronic anti-glaucoma medications and trabeculectomy on tear osmolarity. Eye. 2013;27:1142–50.

    Article  CAS  PubMed  Google Scholar 

  6. Ono T, Yuki K, Ozeki N, Shiba D, Tsubota K. Ocular surface complications after trabeculectomy: incidence, risk factors, time course and prognosis. Ophthalmologica. 2013;230:93–9.

    Article  PubMed  Google Scholar 

  7. Mietz H, Brunner R, Addicks K, Krieglstein GK. Histopathology of an avascular filtering bleb after trabeculectomy with mitomycin-C. J Glaucoma. 1993;2:266–70.

    Article  CAS  PubMed  Google Scholar 

  8. Sagara H, Iida T, Saito K, Noji H, Ogasawara M, Oyamada H. Conservative treatment for late-onset bleb leaks after trabeculectomy with mitomycin C in patients with ocular surface disease. Clin Ophthalmol. 2012;6:1273–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Katz LJ, Cantor LB, Spaeth GL. Complications of surgery in glaucoma: early and late bacterial endophthalmitis following glaucoma filtering surgery. Ophthalmology. 1985;92:959–63.

    Article  CAS  PubMed  Google Scholar 

  10. Azuara-Blanco A, Katz LJ. Dysfunctional filtering blebs. Surv Ophthalmol. 1998;43:93–126.

    Article  CAS  PubMed  Google Scholar 

  11. Mishima S. Some physiological aspects of the precorneal tear film. Arch Ophthalmol. 1965;73:233–41.

    Article  CAS  PubMed  Google Scholar 

  12. Bron AJ, Tiffany JM, Gouveia SM, Yokoi N, Voon LW. Functional aspects of the tear film lipid layer. Exp Eye Res. 2004;78:347–60.

    Article  CAS  PubMed  Google Scholar 

  13. Begley CG, Chalmers RL, Mitchell GL, Nichols KK, Caffery B, Simpson T, et al. Characterization of ocular surface symptoms from optometric practices in North America. Cornea. 2001;20:610–8.

    Article  CAS  PubMed  Google Scholar 

  14. Pisella PJ, Malet F, Lejeune S, Brignole F, Debbasch C, Bara J, et al. Ocular surface changes induced by contact lens wear. Cornea. 2001;20:820–5.

    Article  CAS  PubMed  Google Scholar 

  15. Arita R, Itoh K, Inoue K, Kuchiba A, Yamaguchi T, Amano S. Contact lens wear is associated with decrease of meibomian glands. Ophthalmology. 2009;116:379–84.

    Article  PubMed  Google Scholar 

  16. Arita R, Itoh K, Maeda S, Maeda K, Tomidokoro A, Amano S. Association of contact lens-related allergic conjunctivitis with changes in the morphology of meibomian glands. Jpn J Ophthalmol. 2012;56:14–9.

    Article  PubMed  Google Scholar 

  17. Arita R, Itoh K, Maeda S, Maeda K, Furuta A, Fukuoka S, et al. Proposed diagnostic criteria for obstructive meibomian gland dysfunction. Ophthalmology. 2009;116:2058–63.

    Article  PubMed  Google Scholar 

  18. Mathers WD, Billborough M. Meibomian gland function and giant papillary conjunctivitis. Am J Ophthalmol. 1992;114:188–92.

    CAS  PubMed  Google Scholar 

  19. Sotozono C, Ang L, Koizumi N, Higashihara H, Ueta M, Inatomi T, et al. New grading system for the evaluation of chronic ocular manifestations in patients with Stevens–Johnson syndrome. Ophthalmology. 2007;114:1294–302.

    Article  PubMed  Google Scholar 

  20. Ogawa Y, Okamoto S, Wakui M, Watanabe R, Yamada M, Yoshino M, et al. Dry eye after haematopoietic stem cell transplantation. Br J Ophthalmol. 1999;83:1125–30.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Pisella PJ, Pouliquen P, Baudouin C. Prevalence of ocular symptoms and signs with preserved and preservative free glaucoma medication. Br J Ophthalmol. 2002;86:418–23.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Arita R, Itoh K, Maeda S, Maeda K, Furuta A, Tomidokoro A, et al. Comparison of the long-term effects of various topical antiglaucoma medications on meibomian glands. Cornea. 2012;31:1229–34.

    Article  PubMed  Google Scholar 

  23. Clarke J. Moorfields Bleb Grading System. Moorfields Bleb Grading System Web site. Available at: www.blebs.net/html/Protocol.html. Accessed December 14, 2013.

  24. Park HY, Ahn MD. Imaging of trabeculectomy blebs with Visante anterior segment optical coherence tomography after digital ocular compression. Jpn J Ophthalmol. 2012;56:38–45.

    Article  PubMed  Google Scholar 

  25. Kiuchi T, Okamoto H, Ishii K, Oshika T. Amniotic membrane transplantation for late-onset bleb leakage with scleritis. Jpn J Ophthalmol. 2005;49:56–8.

    Article  PubMed  Google Scholar 

  26. Arita R, Itoh K, Maeda S, Maeda K, Amano S. A newly developed noninvasive and mobile pen-shaped meibography system. Cornea. 2013;32:242–7.

    Article  PubMed  Google Scholar 

  27. Norn MS. Diagnosis of dry eye. In: Lemp MA, Marquardt R, editors. The dry eye: a comprehensive guide. Berlin: Springer; 1992. p. 133–82.

    Chapter  Google Scholar 

  28. Methodologies to diagnose and monitor dry eye disease. report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007;5:108–52.

    Article  Google Scholar 

  29. Bron AJ, Evans VE, Smith JA. Grading of corneal and conjunctival staining in the context of other dry eye tests. Cornea. 2003;22:640–50.

    Article  PubMed  Google Scholar 

  30. Neves Mendes CR. Hida RY, Kasahara N. Ocular surface changes in eyes with glaucoma filtering blebs. Curr Eye Res. 2012;37:309–11.

    Article  PubMed  Google Scholar 

  31. Shields JA, Demirci H, Marr BP, Eagle RC Jr, Shields CL. Sebaceous carcinoma of the eyelids: personal experience with 60 cases. Ophthalmology. 2004;111:2151–7.

    Article  PubMed  Google Scholar 

  32. Russell HC, Chadha V, Lockington D, Kemp EG. Topical mitomycin C chemotherapy in the management of ocular surface neoplasia: a 10-year review of treatment outcomes and complications. Br J Ophthalmol. 2010;94:1316–21.

    Article  CAS  PubMed  Google Scholar 

  33. Crooke ST, Mitomycin WT, Bradner C. a review. Cancer Treat Rev. 1976;3:121–39.

    Article  CAS  PubMed  Google Scholar 

  34. Tomlinson A, Khanal S, Ramaesh K, Diaper C, McFadyen A. Tear film osmolarity: determination of a referent for dry eye diagnosis. Invest Ophthalmol Vis Sci. 2006;47:4309–15.

    Article  PubMed  Google Scholar 

  35. Subcommittee of the International Dry Eye Workshop. The definition and classification of dry eye disease. Report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007;5:75–92.

  36. Labbé A, Terry O, Brasnu E, Van Went C, Baudouin C. Tear film osmolarity in patients treated for glaucoma or ocular hypertension. Cornea. 2012;31:994–9.

    Article  PubMed  Google Scholar 

  37. Lemp MA. Report of the National Eye Institute/Industry workshop on Clinical Trials in Dry Eyes. CLAO J. 1995;21:221–32.

    CAS  PubMed  Google Scholar 

  38. Gipson IK. Distribution of mucins at the ocular surface. Exp Eye Res. 2004;78:379–88.

    Article  CAS  PubMed  Google Scholar 

  39. Amar N, Labbé A, Hamard P, Dupas B, Baudouin C. Filtering blebs and aqueous pathway: an immunocytological and in vivo confocal microscopy study. Ophthalmology. 2008;115:1154–61.

    Article  PubMed  Google Scholar 

  40. Tseng SC, Hirst LW, Maumenee AE, Kenyon KR, Sun TT, Green WR. Possible mechanisms for the loss of goblet cells in mucin-deficient disorders. Ophthalmology. 1984;91:545–52.

    Article  CAS  PubMed  Google Scholar 

  41. Arita R, Itoh K, Inoue K, Amano S. Noncontact infrared meibography to document age-related changes of the meibomian glands in a normal population. Ophthalmology. 2008;115:911–5.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Mr. Toshiro Tango for the statistical analysis of the data and Mr. Reuben M. Gerling for the editing of this manuscript.

Ethical standard

We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during this research.

Conflicts of interest

H. Sagara, None; T. Sekiryu, None; H. Noji, None; M. Ogasawara, None; Y. Sugano, None; H. Horikiri, None.

Author information

Authors and Affiliations

  1. The Marui Eye Clinic, 1-83-3 Honjinmae, Haramachi-ku, Minamisoma, Fukushima, 975-0062, Japan

    Hideto Sagara

  2. Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan

    Hideto Sagara, Tetsuju Sekiryu, Hiroki Noji, Masashi Ogasawara, Yukinori Sugano & Hiroko Horikiri

Authors
  1. Hideto Sagara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tetsuju Sekiryu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroki Noji
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masashi Ogasawara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yukinori Sugano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroko Horikiri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hideto Sagara.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sagara, H., Sekiryu, T., Noji, H. et al. Meibomian gland loss due to trabeculectomy. Jpn J Ophthalmol 58, 334–341 (2014). https://doi.org/10.1007/s10384-014-0324-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10384-014-0324-6

Keywords

Search

Navigation