Abstract: Objective: To evaluate the clinical efficacy of using warm compresses on the eyelid combined with meibomian gland expression preoperatively in cataract patients with mild to moderate meibomian gland dysfunction (MGD). Methods: This study was based on a prospective clinical research design. Mild to moderate MGD patients 50-85 years old who underwent cataract surgery in the Eye Hospital, Wenzhou Medical University from September 2019 to June 2020, were divided randomly into an experimental group and a control group. The experimental group were treated with warm compresses and meibomian gland expression three times before cataract surgery, while the control group underwent cataract surgery without pretreatment. The parameters included Schirmer Ⅰ test (SⅠT), tear break-up time (TBUT), corneal and conjunctival stain, lid margin, expressibility, meibum quality, keratography-5M including noninvasive tear meniscus height (NITMH), noninvasive tear break-up time (NITBUT), and meibomian gland loss (MGL), and the ocular surface disease index (OSDI) questionnaire were measured before and after MGD treatment, and 1 week, 1 month and 3 months postoperatively. Data was analyzed by a generalized estimation equation (GEE), generalized linear mixed model (GLMM), independent-samples t test and Mann-Whitney U test. Results: A total of 68 patients (68 eyes) were included for analysis, with 34 patients in each group. In the experimental group, the lid margin, meibomian expression, SⅠT, and TBUT and OSDI scores were significantly improved after MGD treatment (P<0.05). Corneal fluorescein staining increased significantly one week after cataract surgery (P=0.002), and returned to baseline level 1 month postoperatively. There was significantly less deterioration in meibomian quality in the experimental group compared to the control group during the follow-up period after surgery (P<0.05). Worsening of the lid margin was significantly lighter than that of the control group at 1 week after cataract surgery; the change in NITMH was less, and OSDI scores were higher in the experimental group than those in the control group at 1 month after cataract surgery (P<0.05). In the control group, the lid margin and SⅠT deteriorated significantly 1 week postoperatively and had restored to preoperative levels at 1 month after surgery. Meibomian quality deteriorated 1 week postoperatively, while NITMH decreased at 1 month after surgery, and both of these had recovered to preoperative levels at the 3-month follow-up. Conclusions: Preoperative management of MGD with warm eyelid compresses and meibomian gland expression can improve the function of the meibomian gland and alleviate dry eye symptoms after cataract surgery.
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