Risk factors for persistent dry eye after cataract surgery

Who is most likely to get dry eye after cataract surgery?

In this study, they looked at patients who underwent cataract surgery. If their OSDI scores were greater than 12 three months after surgery, they deemed them as having persistent dry eye symptoms.  The point of the study was to analyze what was different about those patients at the time of surgery and soon after: is it possible to predict who will have persistent dry eye after cataract surgery?

One-third (31 of 96) of the patients had persistent dry eye symptoms after cataract surgery. Ouch!

Risk factors were determined to be:

• High OSDI scores before surgery

• Low TBUT 1 month after surgery

• Low MG orifice obstruction score

• Increased MG dropout

In other words, if they were symptomatic before cataract surgery, and/or if they had meibomian gland issues. 

Eye doctors need to be screening cataract patients for dry eye, advising them on risks and advising them on treatments for dry eye prior to cataract surgery.

Perioperative Ocular Parameters Associated With Persistent Dry Eye Symptoms After Cataract Surgery.

Cornea. 2018 Mar 14. doi: 10.1097/ICO.0000000000001572. [Epub ahead of print]

Choi YJ1, Park SY, Jun I, Choi M, Seo KY, Kim EK, Kim TI.

Abstract

PURPOSE:

To evaluate perioperative dry eye (DE) syndrome and meibomian gland dysfunction (MGD) parameters associated with persistent DE symptoms after cataract surgery.

METHODS:

We enrolled patients who underwent uncomplicated cataract surgery without previous ocular comorbidities and previous use of ophthalmic treatment except for artificial tears at a single tertiary hospital. Lipid layer thickness, meibomian gland (MG) dropout, tear breakup time, Oxford staining score, lid margin abnormality, meibum quality, meibum expressibility, MG orifice obstruction, MGD stage, Ocular Surface Disease Index (OSDI), and Schirmer test score were prospectively assessed in order at baseline and 1 and 3 months postoperative. Patients with an OSDI score >12 at 3 months postoperative were defined as patients with persistent DE symptoms after cataract surgery. Multivariate logistic regression was then used to determine risk factors for persistent DE symptoms.

RESULTS:

A total of 116 eyes of 116 patients were enrolled, and 96 patients completed all examinations until 3 months postoperative. Thirty-one patients had persistent DE symptoms at 3 months postoperative. The Oxford staining score, lid margin abnormality, meibum quality, and MGD stage were improved over time. Baseline high OSDI scores [odds ratio (OR), 1.072; P = 0.001] and 1 month postoperative low tear breakup time, low MG orifice obstruction scores, and increased MG dropout (OR, 0.322; P < 0.001, OR, 0.291; P = 0.015, OR, 1.145; P = 0.007, respectively) were determined as risk factors for persistent DE symptoms after cataract surgery.

CONCLUSIONS:

Ocular parameters at baseline and at 1 month postoperative were important in predicting persistent DE symptoms after cataract surgery.

Abstract: Is cataract surgery the old-but-new LASIK, as regards dry eye?

I think this is the most dramatically worded study I've seen on cataract surgery and dry eye. Way to go Dr Galor! It's definitely making me want to go back and re-read some others to remind myself what the numbers were.

Nothing in this surprises me particularly, but it's really something to see it in print. I'm very pleased to see they used a survey that includes the word burning - that's one of the most common and crippling symptoms for those with severe symptoms, but it is omitted way too often in symptom surveys, as  TFOS DEWS II epidemiology report points out. And I love that the participants are almost all men, who are not the primary dry eye demographic, as it makes the results that much more interesting.

• 95% of participants were men

• 1/3 of patients have persistent postsurgical pain

• Prevalence compared with refractive surgery, e.g. LASIK

Cornea. 2017 Dec 7

Epidemiology of Persistent Dry Eye-Like Symptoms After Cataract Surgery.

Iglesias E1, Sajnani R2, Levitt RC3,4,5, Sarantopoulos CD3, Galor A1,6.

Abstract 

PURPOSE:

To evaluate the frequency and risk factors for persistent postsurgical pain (PPP) after cataract surgery, defined as mild or greater dry eye (DE)-like symptoms 6 months after surgery. 

METHODS:

This single-center study included 86 individuals who underwent cataract surgery between June and October 2016 and had DE symptom information available 6 months after surgery. Patients were divided into 2 groups: controls were defined as those without DE symptoms 6 months after surgery (defined by a Dry Eye Questionnaire 5 (DEQ5) score

RESULTS:

Mean age of the study population was 71 ± 8.6 years; 95% (n = 82) were men. DE-like symptoms were reported in 32% (n = 27) of individuals 6 months after cataract surgery; 10% (n = 8) reported severe symptoms (DEQ5 ≥12). Patients with DE-like symptoms after cataract extraction also had higher ocular pain scores and specific ocular complaints (ocular burning, sensitivity to wind and light) compared with controls with no symptoms. A diagnosis of nonocular pain increased the risk of DE-like symptoms after cataract surgery (odds ratio 4.4, 95% confidence interval 1.58-12.1, P = 0.005). 

CONCLUSIONS:

Mild or greater PPP occurred in approximately 1/3 of individuals after cataract surgery. Prevalence of severe PPP is in line with that of refractive surgery, dental implants, and genitourinary procedures.

Abstract: Drop in goblet cell density after cataract surgery

This study used several metrics to evaluate ocular surface changes after cataract surgery. Apparently the only thing measured in this study that did not return to baseline within the study period was goblet cell density, which could explain a lot about why some people get significant dry eye symptoms after cataract surgery.

Changes in the tear film and ocular surface after cataract surgery.

PURPOSE:
To evaluate changes in corneal sensitivity, tear film function, and ocular surface stability in patients after cataract surgery.

METHODS:
This hospital-based prospective randomized trial included 48 eyes from 30 patients who underwent phacoemulsification. Slit-lamp examination, Schirmer test 1 (ST1), and measurement of corneal sensitivity and tear film breakup time (BUT) were performed for all patients 1 day before and 1 day, 1 month, and 3 months after surgery. In addition, conjunctival impression cytology from the temporal region of the conjunctiva was simultaneously performed.

RESULTS:
Corneal sensitivity at the center and temporal incision sites had decreased significantly at 1 day postoperatively (P = .021, P < .001). However, the sensitivity had returned to almost the preoperative level 1 month postoperatively. The mean postoperative ST1 results were no different from preoperative values. On the other hand, BUT results had decreased significantly at 1 day postoperatively (P = .01) but had returned to almost the preoperative level 1 month postoperatively. Mean goblet cell density (GCD) had decreased significantly at 1 day, 1 month, and 3 months postoperatively (P < .001). In addition, decrease in GCD and cataract operative time were highly correlated (r (2) = 0.65).

CONCLUSIONS:
The decrease in GCD, which was correlated with operative time, had not recovered at 3 months after cataract surgery. Therefore, microscopic ocular surface damage during cataract surgery seems to be one of the pathogenic factors that cause ocular discomfort and dry eye syndrome after cataract surgery.

Jpn J Ophthalmol. 2012 Feb 3. [Epub ahead of print]
Oh T, Jung Y, Chang D, Kim J, Kim H.
Department of Ophthalmology and Visual Science, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #62 Yeouido-dong, Yeongdeungpo-gu, Seoul, 150-713, Korea.