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To determine whether amniotic membrane transplantation can be used to treat symptomatic bullous keratopathy displaying poor visual potential. Methods: Amniotic membrane transplantation was performed at 5 centers on 50 consecutive eyes (50 patients) with symptomatic bullous keratopathy and poor visual potential. The underlying causes of bullous keratopathy included aphakia (9 eyes), pseudophakia (19 eyes), failed grafts (9 eyes), and others (13 eyes). Results: During the follow-up period of 33.8 weeks (3-96 weeks) after amniotic membrane transplantation, 43 (90%) of 48 eyes with intolerable pain preoperatively became pain free postoperatively. Among the 5 eyes with residual pain, 3 received repeated amniotic membrane transplantation, 1 required a conjunctival flap for pain relief, and 1 had reduced pain. Epithelial defects in 45 (90%) of 50 eyes created and coveredbyamnioticmembranehealedrapidlywithin3weeks. Only 4 eyes (8%) showed recurrent surface breakdown. Epithelial edema or bullae recurred in a smaller area in 5 eyes (10%) and pseudopterygium developed in 1 eye. Conclusion: Amniotic membrane transplantation can be considered as an alternative to conjunctival flaps in alleviating pain, promoting epithelial healing, and preserving cosmetic appearance in patients with symptomatic bullous keratopathy and poor visual potential.

Invasive orifice penetration and intraductal probing seems to provide lasting rapid symptom relief for patients with O-MGD. Probing findings in this study frequently included (1) mild resistance upon orifice penetration, (2) proximal duct gritty tactile and aural sensation suggestive of keratinized cellular debris, and (3) focal variable resistance deeper within the duct, which may be relieved with the probe, suggestive of fibrovascular tissue. Taken together, these findings may offer probing characteristics that may allow for a grading system for duct obstruction. The postprobing improvement of symptoms not previously appreciated supports the notion that meibomian gland disease exists subclinically.

PurposeTo investigate the impact of meibomian gland probing (MGP) on meibomian gland (MG) area from the upper lids of patients with obstructive meibomian gland dysfunction (o-MGD).MethodsRetrospective study comparing pre-MGP/post-MGP non-contact infrared meibography results in patients with o-MGD, viewing signs of MG growth within total measurement field.ResultsPost-MGP meibography of 34 lids (19 patients, ≥4.5 to ≤12 months’ follow-up) showed 41.2% with MG growth. Ten lids had meibographies suitable for analysis, showing significant collective (116 glands) increase in mean individual glandular area (MIGA) of 4.87% (p=0.0145). Four of 10 lids independently showed significant increase in MIGA, ranging from 10.70% to 21.13% (p<0.0001, p=0.0277, p=0.0292, p=0.0345), while six did not.At >12 and <25 months’ follow-up, 16 lids (9 additional patients) had follow-up showing 25% with signs of MG growth. Analysis of three lids showed a significant collective (33 glands) increase in MIGA of 11.19% (p=0.0004). Two of three lids independently showed significant increase in MIGA of 13.73% and 20.00% (p=0.0097, p=0.0001). Collectively, for all 13 analysed lids (149 glands), there was a significant increase of 6.38% in total glandular area (p=0.0447) and a significant increase of 6.23% in MIGA (p=0.0003).ConclusionMGP was associated with increased MG tissue area and growth of atrophied MGs as viewed on meibography. MGP provides unequivocal physical proof of a patent meibum outflow tract through the natural orifice, and may promote glandular growth in part by direct mechanical establishment of a patent duct/orifice system.