Change of tear lipid mediators in a post-trabeculectomy cohort

Purpose: Trabeculectomy surgery could affect ocular surface disease (OSD) in several ways, through cessation of long term glaucoma eyedrops, exposure to operative mitomycin C and post-operative eyedrops including corticosteroids and aminoglycosides and reduction in eyelid hygiene measures. Previously we showed the relevance of tear lipid mediators (also referred oxylipins) in OSD. Here, we aim to evaluate changes of these lipids in a post-trabeculectomy cohort. Methods: Patients undergoing trabeculectomy were prospectively evaluated and had tear collected using Schirmer's strips, preoperatively and postoperatively at 0.5, 1.0 and 3.0 years. Lipid mediators were analyzed using liquid chromatography mass spectrometry. Results: The normalized concentrations of 40 lipid mediators were between 0.1 and 8.0 ng/mL, whereas docosahexaenoic acid (DHA), Arachidonic acid (AA) and eicosapentaenoic acid (EPA) ranged up to a few hundred ng/mL. The concentrations of lipid mediators, except DHA, EPA, and thromboxane (TXB₁), showed reduction after surgery. At the last visit, these lipids were significantly reduced by ¹/₃ to ½, compared to pre-operative values: 8-HETE, 15-HETE, 15-oxoETE, 11-HDoHE, 17-HDoHE, and 20-OH-LTB₄. To examine collective changes of lipids, clustering analysis revealed 10 groups of lipids consistent with known metabolic pathways. Results: An increase in the level of 2,3-dinor-8-isoPGF_2α between 0 and 0.5 year was associated with inferior corneal staining at 0.5 year. In 14 patients who required post-operative needling, six lipid mediators were found to be significantly higher at 1.0 year compared to non-needled patients. Conclusions: In this 3-years study, trabeculectomy reduced the tear level of pro-inflammatory lipid mediators. Patients who required needling of the bleb to maintain surgical success may have a chronic underlying inflammatory process associated with fibrosis.