Meibomian gland dropout rate as a method to assess meibomian gland morphologic changes during use of preservative-containing or preservative-free topical prostaglandin analogues

Abstract

Purpose To investigate the usefulness of meibomian gland (MG) dropout rate in the evaluation of MG morphological change associated with the use of prostaglandin for glaucoma treatment through the association between MG and the ocular surface parameters and medication duration and presence of preservative. Methods This cross-sectional study was conducted on 88 eyes of 88 patients who were diagnosed with glaucoma and used only Tafluprost as treatment. The patients were divided into four “user” groups: 1) 23 patients used preservative-free (PF) Tafluprost for 6 months; 2) 21 patients used preservative-containing (PC) Tafluprost for 6 months; 3) 23 patients used PF-Tafluprost for 24 months; 4) 21 patients used PC-Tafluprost for 24 months. Ocular surface parameters and the MG condition, including MG dropout rate and meiboscale, were evaluated. Multiple regression was used to identify associations. Results There were significant differences in age (p = 0.003), tear breakup time (p = 0.016), lid margin abnormality (p = 0.016), expressibility (p = 0.039), meiboscale (p<0.001), and MG dropout rate (p<0.001) among the 4 groups. MG dropout rate and meiboscale showed significant differences in all post hoc analyses, except for the comparison between the PF-Tafluprost and PC-Tafluprost 6-month user groups. Medication duration, preservative status, and meiboscale were significantly correlated with MG dropout rate (p<0.001, p = 0.024, p<0.001, respectively). In the 6-month user group, preservative status significantly correlated with MG dropout rate (p = 0.015). However, in the 24-month user group, meiboscale was the only parameter significantly associated with MG dropout rate (p<0.001). Conclusion MG dropout rate in patients using Tafluprost showed a significant correlation with medication duration and preservative status. This result indicates MG dropout rate reflects MG morphologic change associated with prostaglandin.

The protective effect of 3% diquafosol on meibomian gland morphology in glaucoma patients treated with prostaglandin analogs: a 12-month follow-up study

“…Next, the original color photograph was converted into an 8-bit type image. We then applied automatic threshold identification to discriminate the meibomian gland area from the non-meibomian gland area [26]. The non-meibomian gland area was regarded as the meibomian gland dropout area.…”

Changes in ocular surface and Meibomian gland after penetrating Keratoplasty

“…The effects of preservatives and antiglaucoma medications on meibomian glands have been previously reported, and are known to cause functional and structural changes in meibomian glands [29][30][31]. Antiglaucoma medications cause subclinical inflammation which results in keratinization of meibomian gland orifice and subsequent stagnation of meibum [29].…”

“…Antiglaucoma medications cause subclinical inflammation which results in keratinization of meibomian gland orifice and subsequent stagnation of meibum [ 29 ]. Lee et al demonstrated worsening of lid margin abnormality, expressibility of meibum, and meiboscore in patients using preservative-containing antiglaucoma medications [ 30 ]. However, in our study, the groups with or without antiglaucoma medications only differed in SIT values.…”

Comparison of the Intraocular Pressure-Lowering Effect and Safety of Preservative-Free And Preservative-Containing Brimonidine/Timolol Fixed-Combination Ophthalmic Solutions in Patients with Open-Angle Glaucoma

“…Lee et al reported that the meibomian gland dropout rate caused by glaucoma medication use had a significant correlation with medication duration and preservative status. 29 Finally, there is a possibility that the absence of BAK does not affect the occurrence of side effects in BTFC. Murugesan et al found that there was no significant difference in tear neuropeptide levels and central corneal/confocal corneal subbasal nerve fiber layer density between BAK-containing and BAK-free antiglaucoma therapies.…”