International Ophthalmology

, Volume 39, Issue 4, pp 745–752 | Cite as

Influence of glaucoma surgery on the ocular surface using oculus keratograph

  • Sue Zhong
  • Hezheng ZhouEmail author
  • Xiao Chen
  • Wenqiang Zhang
  • Liqun Yi
Original Paper



To investigate the influence of trabeculectomy and phacotrabeculectomy on the ocular surface.


Retrospective, case–control study.


Eighty-one samples without dry eyes were recruited and divided into three groups, including phacoemulsification group (N = 30) as control group, trabeculectomy group (N = 27) and phacotrabeculectomy group (N = 24) as study groups. Ocular surface parameters, including noninvasive keratograph first (NifBUT) and average (NiaBUT) tear film breakup time, tear meniscus height (TMH) and corneal fluorescein stain (CFS), were estimated preoperatively, at 3 days, 1 month and 3 months postoperatively using oculus keratograph.


No significant difference was observed in ocular surface parameters at baseline among three groups (p > 0.05). The magnitude of NifBUT and NiaBUT was reduced at 3 days and 1 month postoperatively in phacotrabeculectomy group, but greater than that in the other two groups (All p < 0.001). In all the groups, both the NifBUT and NiaBUT tended to recover at 1 and 3 months postoperatively, whereas both of them did not recover to baseline at 3 months postoperatively in trabeculectomy (NifBUT, p = 0.001; NiaBUT, p < 0.001) and phacotrabeculectomy group (NifBUT, p < 0.001; NiaBUT, p = 0.020). TMH was raised at 3 days postoperatively and restored to the baseline level at 1 and 3 months postoperatively for three groups (p > 0.05). CFS was elevated at 3 days postoperatively and different in recovery at 1 and 3 months postoperatively for three groups.


The influence of phacotrabeculectomy on ocular surface is worse than that of trabeculectomy for the short run and is not distinct different for a long time.


Glaucoma Dry eye Ocular surface Breakup time Oculus keratograph 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    Han KE, Yoon SC, Ahn JM et al (2014) Evaluation of dry eye and meibomian gland dysfunction after cataract surgery. Am J Ophthalmol 157(6):1144–1150.e1141CrossRefGoogle Scholar
  2. 2.
    Malhotra C, Singh S, Chakma P, Jain AK (2015) Effect of oral omega-3 Fatty Acid supplementation on contrast sensitivity in patients with moderate meibomian gland dysfunction: a prospective placebo-controlled study. Cornea 34(6):637–643CrossRefGoogle Scholar
  3. 3.
    Listed NA (2007) The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop. Ocul Surf 5(2):75–92CrossRefGoogle Scholar
  4. 4.
    Shimazaki-Den S, Dogru M, Higa K, Shimazaki J (2013) Symptoms, visual function, and mucin expression of eyes with tear film instability. Cornea 32(9):1211–1218CrossRefGoogle Scholar
  5. 5.
    Cetinkaya S, Mestan E, Acir NO, Cetinkaya YF, Dadaci Z, Yener HI (2015) The course of dry eye after phacoemulsification surgery. BMC Ophthalmol 15:68CrossRefGoogle Scholar
  6. 6.
    Bower KS, Sia RK, Ryan DS, Mines MJ, Dartt DA (2015) Chronic dry eye in photorefractive keratectomy and laser in situ keratomileusis: manifestations, incidence, and predictive factors. J Cataract Refract Surg 41(12):2624–2634CrossRefGoogle Scholar
  7. 7.
    Neves Mendes CR, Hida RY, Kasahara N (2012) Ocular surface changes in eyes with glaucoma filtering blebs. Curr Eye Res 37(4):309–311CrossRefGoogle Scholar
  8. 8.
    Bron AJ, Abelson MB, Ousler G, Pearce E, Tomlinson A, Yokoi N, Smith JA, Begley C, Caffery B, Nichols K, Schaumberg D (2007) Methodologies to diagnose and monitor dry eye disease: report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop. Ocul Surf 5(2):108–152CrossRefGoogle Scholar
  9. 9.
    Toda I, Tsubota K (1993) Practical double vital staining for ocular surface evaluation. Cornea 12(4):366–367CrossRefGoogle Scholar
  10. 10.
    Park Y, Hwang HB, Kim HS (2016) Observation of influence of cataract surgery on the ocular surface. PLoS ONE 11(10):e0152460CrossRefGoogle Scholar
  11. 11.
    Ling TE, Othman K, Yan OP et al (2017) Evaluation of ocular surface disease in Asian patients with primary angle closure. Open Ophthalmol J 11:31–39CrossRefGoogle Scholar
  12. 12.
    Cho YK, Kim MS (2009) Dry eye after cataract surgery and associated intraoperative risk factors. Kor J Ophthalmol KJO 23(2):65–73CrossRefGoogle Scholar
  13. 13.
    Tao A, Chen Z, Shao Y et al (2013) Phacoemulsification induced transient swelling of corneal Descemet’s Endothelium Complex imaged with ultra-high resolution optical coherence tomography. PLoS ONE 8(11):e80986CrossRefGoogle Scholar
  14. 14.
    Ablamowicz AF, Nichols JJ (2016) Ocular surface membrane-associated mucins. Ocul Surf 14(3):331–341CrossRefGoogle Scholar
  15. 15.
    Oh T, Jung Y, Chang D, Kim J, Kim H (2012) Changes in the tear film and ocular surface after cataract surgery. Jpn J Ophthalmol 56(2):113–118CrossRefGoogle Scholar
  16. 16.
    Liu W, Li H, Lu D et al (2010) The tear fluid mucin 5AC change of primary angle-closure glaucoma patients after short-term medications and phacotrabeculectomy. Mol Vis 16:2342–2346Google Scholar
  17. 17.
    Dartt DA (2004) Dysfunctional neural regulation of lacrimal gland secretion and its role in the pathogenesis of dry eye syndromes. Ocul Surf 2(2):76–91CrossRefGoogle Scholar
  18. 18.
    Belmonte C, Acosta MC, Gallar J (2004) Neural basis of sensation in intact and injured corneas. Exp Eye Res 78(3):513–525CrossRefGoogle Scholar
  19. 19.
    Sitompul R, Sancoyo GS, Hutauruk JA, Gondhowiardjo TD (2008) Sensitivity change in cornea and tear layer due to incision difference on cataract surgery with either manual small-incision cataract surgery or phacoemulsification. Cornea 27(Suppl 1):S13–S18CrossRefGoogle Scholar
  20. 20.
    Ji H, Zhu Y, Zhang Y, Li Z, Ge J, Zhuo Y (2016) Dry eye disease in patients with functioning filtering blebs after trabeculectomy. PLoS ONE 11(3):e0152696CrossRefGoogle Scholar
  21. 21.
    Sagara H, Sekiryu T, Noji H, Ogasawara M, Sugano Y, Horikiri H (2014) Meibomian gland loss due to trabeculectomy. Jpn J Ophthalmol 58(4):334–341CrossRefGoogle Scholar
  22. 22.
    Knop E, Knop N, Schirra F (2009) Meibomian glands. Part II: physiology, characteristics, distribution and function of meibomian oil. Ophthalmol Z Dtsch Ophthalmol Ges 106(10):884–892Google Scholar
  23. 23.
    Li XM, Hu L, Hu J, Wang W (2007) Investigation of dry eye disease and analysis of the pathogenic factors in patients after cataract surgery. Cornea 26(9 Suppl 1):S16–S20CrossRefGoogle Scholar
  24. 24.
    Aguayo Bonniard A, Yeung JY, Chan CC, Birt CM (2016) Ocular surface toxicity from glaucoma topical medications and associated preservatives such as benzalkonium chloride (BAK). Exp Opin Drug Metab Toxicol 18:1–11Google Scholar
  25. 25.
    Perenyi K, Dienes L, Kornafeld A et al (2017) The effect of tear supplementation with 0.15% preservative-free zinc-hyaluronate on ocular surface sensations in patients with dry eye. J Ocul Pharmacol Ther Off J Assoc Ocul Pharmacol Ther 33(6):487–492CrossRefGoogle Scholar
  26. 26.
    Kasetsuwan N, Satitpitakul V, Changul T, Jariyakosol S (2013) Incidence and pattern of dry eye after cataract surgery. PLoS ONE 8(11):e78657CrossRefGoogle Scholar
  27. 27.
    Ono T, Yuki K, Ozeki N, Shiba D, Tsubota K (2013) Ocular surface complications after trabeculectomy: incidence, risk factors, time course and prognosis. Ophthalmol J Int d’ophtalmol Int J Ophthalmol Z Augenheilkd 230(2):93–99CrossRefGoogle Scholar
  28. 28.
    Uchino M, Nishiwaki Y, Michikawa T et al (2011) Prevalence and risk factors of dry eye disease in Japan: Koumi study. Ophthalmology 118(12):2361–2367CrossRefGoogle Scholar
  29. 29.
    Jiang Y, Ye H, Xu J, Lu Y (2014) Noninvasive keratograph assessment of tear film break-up time and location in patients with age-related cataracts and dry eye syndrome. J Int Med Res 42(2):494–502CrossRefGoogle Scholar
  30. 30.
    Lee SY, Wong TT, Chua J, Boo C, Soh YF, Tong L (2013) Effect of chronic anti-glaucoma medications and trabeculectomy on tear osmolarity. Eye 27(10):1142–1150CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Sue Zhong
    • 1
    • 2
    • 3
  • Hezheng Zhou
    • 1
    • 2
    Email author
  • Xiao Chen
    • 2
  • Wenqiang Zhang
    • 2
  • Liqun Yi
    • 3
  1. 1.Southern Medical UniversityGuangzhouChina
  2. 2.Department of OphthalmologyWuhan General Hospital of the People’s Liberation ArmyWuhanChina
  3. 3.Department of OphthalmologyThe Second People’s Hospital of Three Gorges UniversityYichangChina

Personalised recommendations