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Sun CC, Hsu SL, Liang CM, Tsai YY, Lin PY. Bridging the gap in managing dry eye disease: a consensus report by the Taiwan society of cataract and refractive surgeons. BMC Ophthalmol 2024; 24:314. [PMID: 39075430 PMCID: PMC11285138 DOI: 10.1186/s12886-024-03565-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/08/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND An impaired ocular surface presents substantial challenges in terms of planning for cataract surgery. As a multifactorial ocular disorder, dry eye disease (DED) is common in the general population and prevalent in patients scheduled for lens replacement surgery. Cataract surgery can exacerbate DED and worsen several ocular parameters. Timely diagnosis and appropriate treatment of DED are vital to ensuring positive ophthalmic surgical outcomes. This consensus report of the Taiwan Society of Cataract and Refractive Surgeons (TSCRS) regarding the management of DED before, during, and after cataract surgery highlights the gaps between clinical guidelines and several aspects of DED, including diagnostic testing, diagnostic criteria, and clinical practice treatment. METHODS An expert panel of five specialists in the field of ophthalmology was recruited to develop consensus statements regarding the management of DED in both the general population and in patients undergoing cataract surgery in Taiwan. Two separate meetings of the five specialists, who were endorsed by the TSCRS, were convened for this purpose. A survey questionnaire consisting of binary or multiple-choice questions was developed through a consensus-driven formulation process. A percentage value was calculated for each statement, and a minimum of 60% agreement (equivalent to three out of five members) was required to achieve consensus. The second discussion meeting involved the presentation of the finalized consensus statements and concluded the consensus development process. Lastly, the finalized consensus statements were approved by all the experts, and the formulated recommendations for DED in the general population and prospective cataract surgery patients were accordingly presented. RESULTS The optimal algorithm for managing DED in the general population and in patients scheduled for cataract surgery was developed to address the unmet needs of this cohort in Taiwan. CONCLUSION This report provides recommendations for managing dry eye disease. It is essential to screen and confirm DED through endorsed questionnaires and tests and then diagnose it. Treatment and management of DED should follow a stepwise approach. Screening and diagnosing DED is also recommended before cataract surgery. After cataract surgery, relatively aggressive treatment strategies are recommended to manage DED effectively.
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Affiliation(s)
- Chi-Chin Sun
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shiuh-Liang Hsu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan.
| | - Pei-Yu Lin
- Department of Ophthalmology, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.
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Dossari SK. Post-refractive Surgery Dry Eye: A Systematic Review Exploring Pathophysiology, Risk Factors, and Novel Management Strategies. Cureus 2024; 16:e61004. [PMID: 38916023 PMCID: PMC11194137 DOI: 10.7759/cureus.61004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2024] [Indexed: 06/26/2024] Open
Abstract
Dry eye disease frequently manifests following corneal refractive procedures, significantly impacting patients' quality of life. This review systematically synthesizes current evidence on the pathophysiological mechanisms, risk factors, and therapeutic interventions for post-refractive surgery dry eye. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of literature published until August 2023 was conducted, focusing on post-refractive surgery dry eye. Eighteen relevant studies were identified through screening and eligibility assessment. A qualitative synthesis of outcomes was performed using narrative and thematic analysis methods. Surgically induced neurotrophic deficiency, stemming from nerve transection, triggers a cascade of events including apoptosis, inflammation, and lacrimal dysfunction, ultimately leading to tear film instability. Risk factors such as female gender, thyroid eye disease, meibomian gland dysfunction, higher ablation depths, and the use of LASIK over surface ablation exacerbate the condition. While conventional treatments like artificial tears provide temporary relief, emerging interventions such as nerve growth factors, matrix metalloproteinase inhibitors, serum eye drops, and specialized contact lenses show promise in promoting nerve regeneration and epithelial healing. Strategies such as customized ablation profiles, smaller optical zones, and nerve-sparing techniques like small incision lenticule extraction demonstrate potential advantages. A multifaceted therapeutic approach targeting neuroprotection, anti-inflammatory mechanisms, and tear film stabilization is imperative for effectively managing post-refractive surgery dry eye. Future research should focus on evaluating prognostic biomarkers, exploring precision medicine approaches, and investigating neuroprotective adjuvants to further enhance treatment outcomes.
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Affiliation(s)
- Saif K Dossari
- Department of Surgery, King Faisal University, Al-Hofuf, SAU
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Lee SH, Chun YS, Kim KW. Ocular surface parameter changes in the untreated fellow eye after unilateral cataract surgery with short-term administration of anti-inflammatory eye drops. Sci Rep 2024; 14:1080. [PMID: 38212520 PMCID: PMC10784480 DOI: 10.1038/s41598-024-51764-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/09/2024] [Indexed: 01/13/2024] Open
Abstract
This study aimed to investigate the changes in clinical parameters of dry eye disease and meibomian gland dysfunction in both the operated and untreated fellow eyes of patients who underwent unilateral cataract surgery with the short-term administration of anti-inflammatory eye drops in the surgical eye. The medical charts of 57 consecutive patients who underwent unilateral cataract surgery and received 1% prednisolone acetate and non-steroidal anti-inflammatory drug (NSAID, 0.1% bromfenac sodium) eye drops were reviewed. The preoperative ocular surface disease index questionnaire score (38.9 ± 20.5) decreased significantly to 15.2 ± 16.4 at post-surgical 1 week and further to 12.8 ± 11.4 after 1 month. Although meibum quality grade increased and corneal sensitivity decreased at 1 week in operated eyes, corneal erosion scores and Sjogren's International Collaborative Clinical Alliance ocular staining scores even improved over a month in the untreated fellow eyes. The tear matrix metalloproteinase (MMP)-9 grade decreased in both operated eyes and untreated fellow eyes after 1 month from surgery. In conclusion, the short-term topical anti-inflammatory treatment using steroid and NSAID eye drops in the operated eye after cataract surgery decreased subjective ocular surface discomfort and improved ocular surface staining scores and tear MMP-9 expression in the untreated fellow eyes.
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Affiliation(s)
- Seung Hyeun Lee
- Department of Ophthalmology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Yeoun Sook Chun
- Department of Ophthalmology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Kyoung Woo Kim
- Department of Ophthalmology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea.
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Kim AY, Moon JY, Jun RM, Kim HJ, Han KE. Ocular Surface and Tear Cytokine Changes after Cataract Surgery in Patients with Type 2 Diabetes. Ocul Immunol Inflamm 2023; 31:1615-1622. [PMID: 35787222 DOI: 10.1080/09273948.2022.2088565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To evaluate changes in ocular surface indices and tear cytokines after cataract surgery in type 2 diabetic patients. METHODS Ocular surface indices and concentrations of tear cytokines (MCP-1, IL-6, IL-8, and VEGF) were evaluated at baseline and one week and one month postoperatively. RESULTS Patients (30 diabetic and 30 control) were enrolled. In the diabetic group, changes in ocular symptom and tear breakup time remained until one month postoperatively (P < .05, respectively); in the control group, ocular symptom increased at one week postoperatively (P = .015). MCP-1 level in the diabetic group significantly increased postoperatively (all P < .05); however, in the control group, the IL-8 level was significantly decreased postoperatively (all P < .05). MCP-1 concentration was negatively correlated with TBUT in the diabetic group. CONCLUSION Diabetic patients can experience more prominent changes after surgery and these changes were accompanied by an increase of several tear cytokines.
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Affiliation(s)
- Ah Young Kim
- Department of Ophthalmology, Ewha Womans Univsersity, Seoul Hospital, Seoul, South Korea
| | - Ji Young Moon
- Department of Ophthalmology, Ewha Womans Univsersity, Mokdong Hospital, Seoul, South Korea
| | - Roo Min Jun
- Department of Ophthalmology, Ewha Womans Univsersity, Seoul Hospital, Seoul, South Korea
| | - Hyun Jin Kim
- Department of Ophthalmology, Ewha Womans Univsersity, Mokdong Hospital, Seoul, South Korea
| | - Kyung Eun Han
- Department of Ophthalmology, Ewha Womans Univsersity, Mokdong Hospital, Seoul, South Korea
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Lv J, Cao CJ, Li W, Li SL, Zheng J, Yang XL. Tear inflammation related indexes after cataract surgery in elderly patients with type 2 diabetes mellitus. World J Clin Cases 2023; 11:385-393. [PMID: 36686353 PMCID: PMC9850981 DOI: 10.12998/wjcc.v11.i2.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Quantitative studies on the changes in inflammation-related content in tears, especially the effect of diabetes, are lacking. In this study, we measured the preoperative and postoperative tear inflammatory mediator levels in cataract patients, focusing on the expression of inflammatory factors in postoperative cataracts in the diabetic, and investigated the effect of drugs on the control of postoperative inflammation.
AIM To study the expression of inflammatory factors in elderly people with type 2 diabetes after cataract surgery.
METHODS Patients with a mean age of 70.3 ± 6.3 years were divided into group A (composed of elderly patients with cataracts and type 2 diabetes, n = 20 eyes) and group B (patients with age-related cataract, n = 20 eyes). Their tears were collected before each operation and on days 1 and 3, and weeks 1, 2, 3, and 4 post-surgery. Saline (150 μL) was dropped into the conjunctival sac of the surgical eye, followed by oculogyration in four directions. The fluid in the conjunctival sac was extracted using a sterile syringe and stored in Eppendorf tubes at -80 °C until measurement. The expression levels of matrix metalloproteinase-2 (MMP-2), MMP-9, tissue inhibitor of metalloproteinase-1 (TIMP-1), TIMP-2, interleukin-6 (IL-6), and IL-20 in tear fluid were measured using enzyme-linked immunosorbent assays.
RESULTS The postoperative expression levels of MMP-2, MMP-9, TIMP-2, IL-6, and IL-20 in group A were significantly higher than those in group B, whereas the concentration of TIMP-1 in group A remained lower than that in group B. The levels of MMP-2 and IL-6 in both groups continuously increased until the peak in the first postoperative week, and then gradually decreased over the next three weeks. Ultimately, MMP-2 declined to a lower level than that preoperatively at week 4, but IL-6 decreased to the same level as that preoperatively. The level of MMP-9 peaked in the first two weeks postoperative and then returned to the same level as 1-day post-operation. The concentration of TIMP-1 post-operation remained constant at a lower level than before surgery, and TIMP-2 Levels remained stable in both groups. IL-20 content started to increase in the third week after surgery.
CONCLUSION Inflammatory factor levels in tears fluctuated before and post-operation, which indicated more severe postoperative inflammation in the first two weeks.
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Affiliation(s)
- Jun Lv
- Department of Optometry, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Cheng-Jian Cao
- Zigong Academy of Medical Sciences, Zigong First People’s Hospital, Zigong 643000, Sichuan Province, China
| | - Wei Li
- FB Biologie, Philipps-Universitaet Marburg, Marburg 35043, Germany
| | - Shuang-Le Li
- Department of Ophthalmology, Zigong First People’s Hospital, Zigong 643000, Sichuan Province, China
| | - Jun Zheng
- Department of Optometry, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Xiu-Li Yang
- Department of Ophthalmology, Zigong First People’s Hospital, Zigong 643000, Sichuan Province, China
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Chen TM, Lasarev MR, Eaton JS. Retrospective investigation of perioperative risk factors for immediate postoperative corneal erosions in dogs undergoing phacoemulsification. Vet Ophthalmol 2022; 26:191-204. [DOI: 10.1111/vop.13040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/15/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Tiffany Mei Chen
- Department of Surgical Sciences, School of Veterinary Medicine University of Wisconsin Madison USA
| | - Michael R. Lasarev
- Biostatistics and Medical Informatics, School of Medicine and Public Health University of Wisconsin Madison USA
| | - Joshua Seth Eaton
- Department of Surgical Sciences, School of Veterinary Medicine University of Wisconsin Madison USA
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Alpha-Glycerylphosphorylcholine and D-Panthenol Eye Drops in Patients Undergoing Cataract Surgery. J Ophthalmol 2022; 2022:1951014. [PMID: 35711284 PMCID: PMC9197661 DOI: 10.1155/2022/1951014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/28/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022] Open
Abstract
Cataract surgery is widespread. The surgical procedure is associated with damage to the epithelial barrier and interruption of the corneal innervation. In addition, pathological events sustain signs and symptoms that may persist for a long time. Recently, a fixed combination of alpha-glycerylphosphorylcholine and D-Panthenol (Oftassiale) has been available as eye drops. The present study investigated the effects of an Oftassiale therapy in 20 patients undergoing cataract surgery. A comparison group included 20 patients treated with topical hyaluronic acid. Standard prophylactic and anti-inflammatory treatment was prescribed to all patients. Clinical signs and symptoms were assessed over time. In vivo confocal microscopy (IVCM) was performed accordingly. Oftassiale treatment significantly reduced clinical features and improved IVCM outcomes. In addition, therapy was well-tolerated, and no clinically significant adverse events occurred. In conclusion, this study confirmed that IVCM helps assess the tunnel after cataract surgery due to its ability to provide microscopic details in vivo. Topical therapy with alpha-glycerylphosphorylcholine and D-Panthenol eye drops promoted and stabilized the reepithelialization process. This fixed combination also accelerated and modulated the repair of the corneal innervation. Moreover, this treatment was well-tolerated and safe.
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Fujimoto H, Ochi S, Inoue Y, Kiryu J. Upper Eyelid Meibomian Gland Dysfunction is a Risk Factor for Dry Eye Symptoms Following Cataract Surgery in the Early Phase. Clin Ophthalmol 2022; 16:293-302. [PMID: 35153474 PMCID: PMC8828079 DOI: 10.2147/opth.s346606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/27/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hisataka Fujimoto
- Department of Ophthalmology, Kawasaki Medical School, Kurashiki, 701-0192, Okayama, Japan
- Correspondence: Hisataka Fujimoto, Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Okayama, Japan, Tel +81-86-462-1111, Fax +81-86-462-1199, Email
| | | | - Yasushi Inoue
- Inoue Eye Clinic, Tamano, 706-0011, Okayama, Japan
- Yasushi Inoue, Inoue Eye Clinic, 1-14-31 Uno, Tamano, 706-0011, Okayama, Japan, Tel +81-86-331-1030, Fax +81-86-331-1114, Email
| | - Junichi Kiryu
- Department of Ophthalmology, Kawasaki Medical School, Kurashiki, 701-0192, Okayama, Japan
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Abstract
PURPOSE OF REVIEW Given the epidemiology and demographic trends of diabetes mellitus and cataracts, ophthalmologists are likely to encounter patients with both comorbidities at an increasing frequency. Patients with diabetes represent a higher risk population than healthy patients for cataract surgery. In this review, we discuss key risks and risk-mitigation practices when performing cataract surgery on these patients. RECENT FINDINGS Patients with diabetes continue to represent a high-risk surgical population: Nagar et al. suggest a dose-dependent relationship may exist between number of intravitreal injections and likelihood of posterior capsular rupture. However, novel treatments are improving outcomes for patients with diabetes. Several studies have reported intracameral phenylephrine/ketorolac may reduce the incidence of post-operative cystoid macular edema while others have discussed the efficacy of pre-treatment and post-treatment with intravitreal bevacizumab on improving cataract surgery outcomes in patients with diabetic retinopathy. Pre-operatively, ophthalmologists should perform an enhanced evaluation, consider timing and lens selection decisions, and complete any appropriate pre-operative treatment. Peri-operatively, surgeons should be aware of pupillary dilation adjustments, combination surgery options, and potential complications. Post-operatively, clinicians should address pseudophakic cystoid macular edema, diabetic macular edema, diabetic retinopathy, and posterior capsular opacification.
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Affiliation(s)
| | - Christina A Mamalis
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, 77030, USA
| | - Sumitra S Khandelwal
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, 77030, USA.
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Garg P, Gupta A, Tandon N, Raj P. Dry Eye Disease after Cataract Surgery: Study of its Determinants and Risk Factors. Turk J Ophthalmol 2021; 50:133-142. [PMID: 32630999 PMCID: PMC7338747 DOI: 10.4274/tjo.galenos.2019.45538] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objectives To study the incidence of dry eye and its determinants in patients undergoing cataract surgery. Materials and Methods One hundred twenty patients with senile cataract underwent Schirmer's test, tear break-up time (TBUT) test, lissamine green staining of the cornea and conjunctiva, and Ocular Surface Disease Index (OSDI) for evaluation of dry eye preoperatively and again at first and second follow-up examinations at 1 week and 1 month after cataract surgery. Results Mean age of the patients was 59.25+9.77 years and 73 (60.8%) were men. None of the patients had dry eye at the time of enrollment as per the criteria of our study. Postoperatively, Schirmer's test values ranged from 12-35 mm and 8-24 mm at first and second follow-ups, respectively. Mean TBUT was 13.16±2.45 and 9.64±2.20 seconds, while lissamine green staining score was 3 in 67 (55.8%) and 1 in 67 (55.8%) subjects at first and second follow-up, respectively. OSDI values ranged from 1-30 and 10-33 with a mean of 25.97±5.34 and 11.96±7.47 respectively at first and second follow-up. At first follow-up, 89.1% of the 56 patients who underwent phacoemulsification were found to have grade 2 dry eye (p<0.001), while 92.2% of the 64 patients who underwent small-incision cataract surgery (SICS) had grade 2 dry eye (p<0.001). At second follow-up, grade 0 dry eye was observed in 92.2% of the patients who underwent phacoemulsification and 82.1% of the patients who underwent SICS (p<0.001). Conclusion The incidence of dry eye after cataract surgery was high and mostly independent of demographic and anthropometric profile, type of surgical procedure, time of microscope exposure, and amount of energy used. This dryness was transient in nature and showed a declining trend, tending to achieve normalization by the end of 1 month.
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Affiliation(s)
- Pragati Garg
- Era's Lucknow Medical College and Hospital, Clinic of Ophthalmology, Lucknow, India
| | - Aditi Gupta
- Era's Lucknow Medical College and Hospital, Clinic of Ophthalmology, Lucknow, India
| | - Nishi Tandon
- Era's Lucknow Medical College and Hospital, Clinic of Pathology, Lucknow, India
| | - Priyanka Raj
- Era's Lucknow Medical College and Hospital, Clinic of Ophthalmology, Lucknow, India
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Lu Q, Lu Y, Zhu X. Dry Eye and Phacoemulsification Cataract Surgery: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:649030. [PMID: 34307395 PMCID: PMC8295542 DOI: 10.3389/fmed.2021.649030] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 06/17/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate whether dry eye deteriorates after phacoemulsification cataract surgery, and to explore the influential factors. Methods: Studies published before February 2020 indexed on PubMed and the Cochrane Central Register of Controlled Trials were retrieved. A meta-analysis, including meta-regression, a sensitivity analysis, and a subgroup analysis, were performed. Results: Twenty studies with 2,247 eyes were included in the meta-analysis, dry eye-related parameters were investigated preoperatively and 1 month postoperatively. Patients with pre-existing meibomian gland dysfunction (MGD) had worsened subjective symptoms of dry eye (1.31, 95% confidence interval (CI) [0.66, 1.95], P < 0.0001), a reduced tear break-up time (BUT) (−2.27, 95% CI [−2.66, −1.88], P < 0.0001), and a worse corneal fluorescein staining (CFS) score (0.75, 95% CI [0.5, 1.0], P < 0.0001) after phacoemulsification cataract surgery, whereas in the general population, the subjective symptoms score and CFS remained unchanged and BUT decreased slightly after surgery. Patients without diabetes showed significantly reduced total tear secretion after phacoemulsification cataract surgery (−1.25, 95% CI [−1.62, −0.88], P < 0.0001). Conclusion: Dry eye generally remained unchanged 1 month after phacoemulsification cataract surgery. Notably, worsened symptoms and signs of dry eye were observed more frequently in patients with pre-existing MGD. Patients without diabetes were more susceptible to reduced tearing postoperatively. Clinical Trial Registration: Identifier: PERSPERO (2020: CRD42020203316).
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Affiliation(s)
- Qiang Lu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impariment and Restoration, Shanghai, China
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impariment and Restoration, Shanghai, China
| | - Xiangjia Zhu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impariment and Restoration, Shanghai, China
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Lee SH, Chun YS, Moon NJ, Kim KW. Short-term Changes in the Tear Matrix Metalloproteinase 9 Level and Ocular Surface Discomfort after Cataract Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.4.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Corneal nerves in diabetes-The role of the in vivo corneal confocal microscopy of the subbasal nerve plexus in the assessment of peripheral small fiber neuropathy. Surv Ophthalmol 2020; 66:493-513. [PMID: 32961210 DOI: 10.1016/j.survophthal.2020.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023]
Abstract
The cornea's intense innervation is responsible for corneal trophism and ocular surface hemostasis maintenance. Corneal diabetic neuropathy affects subbasal nerve plexus, with progressive alteration of nerves' morphology and density. The quantitative analysis of nerve fibers can be performed with in vivo corneal confocal microscopy considering the main parameters such as corneal nerve fibers length, corneal nerve fibers density, corneal nerve branching density, tortuosity coefficient, and beadings frequency. As the nerve examination permits the detection of early changes occurring in diabetes, the invivo corneal confocal microscopy becomes, over time, an important tool for diabetic polyneuropathy assessment and follow-up. In this review, we summarize the actual evidence about corneal nerve changes in diabetes and the relationship between the grade of alterations and the duration and severity of the disease. We aim at understanding how diabetes impacts corneal nerves and how it correlates with sensorimotor peripheral polyneuropathy and retinal complications. We also attempt to analyze the safety of the most common surgical procedures such as cataract and refractive surgery in diabetic patients and to highlight the specific risk factors. We believe that information about the corneal nerve fibers' condition obtained from the in vivo subbasal nerve plexus investigation may be crucial in monitoring peripheral small fiber polyneuropathy and that it will help with decision-making in ophthalmic surgery in diabetic patients.
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Fondi K, Miháltz K, Vécsei-Marlovits PV. Keratokonjunktivitis sicca und Katarakt-Chirurgie – eine Übersicht der Problematik. SPEKTRUM DER AUGENHEILKUNDE 2020. [DOI: 10.1007/s00717-020-00463-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shimabukuro M, Maeda N, Koh S, Abe K, Kobayashi R, Nishida K. Effects of cataract surgery on symptoms and findings of dry eye in subjects with and without preexisting dry eye. Jpn J Ophthalmol 2020; 64:429-436. [PMID: 32495157 DOI: 10.1007/s10384-020-00744-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare dry eye symptoms and findings in post cataract surgery eyes' with and without preexisting dry eye. STUDY DESIGN Prospective, observational case-control study. METHODS Sixty-seven eyes that had undergone cataract surgery were included; 48 were classified into group D (preexisting dry eye) and 19 into group N (no preexisting dry eye). No subjects received perioperative treatment for dry eye. We evaluated between-group differences in symptom scores, corrected distance visual acuity (CDVA), tear film breakup time (BUT), tear film breakup pattern (BUP), and ocular surface fluorescein staining scores, at 1 week, 1 month, and 3 months postoperatively. RESULTS Symptoms were unchanged in group N, but improved in group D (P < .001) postoperatively. CDVA was improved after surgery in both groups (P < .001). BUT was shorter preoperatively in group D than in group N although this difference was absent 1 month postoperatively. Fluorescein staining scores significantly increased at 1 month postoperatively in group N (P = .01), but did not change in group D. During the perioperative period, the predominant BUP was the random break pattern in both groups (≥ 85%). From 1 week to 3 months, dimple break patterns decreased in group D (P = .007), whereas spot break patterns increased (P = .01). CONCLUSIONS Cataract surgery has an influence on tear film stability and the ocular surface. There was either a transient improvement or worsening of ocular surface wettability in some patients without preexisting dry eye.
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Affiliation(s)
- Mikiko Shimabukuro
- Department of Ophthalmology, Kansai Medical Hospital, Toyonaka, Osaka, Japan
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Room E7, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Naoyuki Maeda
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Room E7, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan.
| | - Shizuka Koh
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Room E7, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Keiichi Abe
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Room E7, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Reiko Kobayashi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Room E7, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Room E7, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
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Abstract
Surgical intervention is the most effective treatment for decreased vision resulting from cataracts. Although the current procedures for cataract surgery are safe and effective, it is well known that several complications can develop after surgery. Postoperative cystoid macular edema (CME) is a well-known complication, and prophylactic medications such as steroids and/or nonsteroidal antiinflammatory drugs are routinely used for its prevention. Ocular surface abnormalities, such as dry eye, have also been reported to develop after cataract surgery. However, the causative mechanisms for postoperative dry eye have not been definitively determined. At present, there are no prophylactic medications that are commonly used to prevent the development of postoperative dry eye. Although nonsteroidal antiinflammatory drugs are very effective in reducing the incidence and degree of postoperative CME, it is known that they can cause adverse side effects, including ocular surface abnormalities. Thus, perioperative medications must be carefully selected to improve surgical outcomes and patient satisfaction. Here, we summarize the results of recent studies on postoperative dry eye and CME that can develop after cataract surgery. We suggest appropriate combinations of medications that can be used to minimize these postsurgical complications.
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Jun I, Choi S, Lee GY, Choi YJ, Lee HK, Kim EK, Seo KY, Kim TI. Effects of Preservative-free 3% Diquafosol in Patients with Pre-existing Dry Eye Disease after Cataract Surgery: A Randomized Clinical Trial. Sci Rep 2019; 9:12659. [PMID: 31477748 PMCID: PMC6718409 DOI: 10.1038/s41598-019-49159-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/20/2019] [Indexed: 11/09/2022] Open
Abstract
Dry eye disease (DED) after cataract surgery has become a critical concern, and various therapeutic options have been developed. Recently, preservative-free diquafosol ophthalmic solution has been introduced; however, its therapeutic effect on DED after cataract surgery has not been reported. We investigated the efficacy of preservative-free diquafosol in patients with pre-existing DED after cataract surgery. We divided subjects who were diagnosed with DED and scheduled to undergo cataract surgery, into 3 groups (preservative-free diquafosol, group 1; preservative-containing diquafosol, group 2; preservative-free hyaluronate, group 3), and each eye drops was administered 6 times daily after surgery. Tear break up time (TBUT), Ocular Surface Disease Index (OSDI), corneal staining score, lid margin abnormality, and meibum quality improved over time in group 1. Groups 1 and 2 had significantly superior TBUT, meibomian gland dysfunction grade, and meibomian gland expressibility throughout the study period than group 3. Meibum quality of group 1 was significantly better than group 2 at 1 and 3 months after surgery. Preservative-free diquafosol showed better efficacy in treating DED after cataract surgery than preservative-containing diquafosol or preservative-free hyaluronate. Preservative-free diquafosol may serve as a reliable option for the management of patients with pre-existing DED after phacoemulsification.
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Affiliation(s)
- Ikhyun Jun
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea.,Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Seonghee Choi
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Geun Young Lee
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Young Joon Choi
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Hyung Keun Lee
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea.,Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Eung Kweon Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea.,Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Kyoung Yul Seo
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Tae-Im Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea. .,Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea.
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18
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Jun I, Choi S, Lee GY, Choi YJ, Lee HK, Kim EK, Seo KY, Kim TI. Effects of Preservative-free 3% Diquafosol in Patients with Pre-existing Dry Eye Disease after Cataract Surgery: A Randomized Clinical Trial. Sci Rep 2019; 9:12659. [PMID: 31477748 DOI: 10.1038/s41598-019-49159-01265910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/20/2019] [Indexed: 05/25/2023] Open
Abstract
Dry eye disease (DED) after cataract surgery has become a critical concern, and various therapeutic options have been developed. Recently, preservative-free diquafosol ophthalmic solution has been introduced; however, its therapeutic effect on DED after cataract surgery has not been reported. We investigated the efficacy of preservative-free diquafosol in patients with pre-existing DED after cataract surgery. We divided subjects who were diagnosed with DED and scheduled to undergo cataract surgery, into 3 groups (preservative-free diquafosol, group 1; preservative-containing diquafosol, group 2; preservative-free hyaluronate, group 3), and each eye drops was administered 6 times daily after surgery. Tear break up time (TBUT), Ocular Surface Disease Index (OSDI), corneal staining score, lid margin abnormality, and meibum quality improved over time in group 1. Groups 1 and 2 had significantly superior TBUT, meibomian gland dysfunction grade, and meibomian gland expressibility throughout the study period than group 3. Meibum quality of group 1 was significantly better than group 2 at 1 and 3 months after surgery. Preservative-free diquafosol showed better efficacy in treating DED after cataract surgery than preservative-containing diquafosol or preservative-free hyaluronate. Preservative-free diquafosol may serve as a reliable option for the management of patients with pre-existing DED after phacoemulsification.
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Affiliation(s)
- Ikhyun Jun
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
- Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Seonghee Choi
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Geun Young Lee
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Young Joon Choi
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Hyung Keun Lee
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
- Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Eung Kweon Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
- Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Kyoung Yul Seo
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Tae-Im Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea.
- Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea.
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19
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Ting DSJ, Ghosh S. Acute corneal perforation 1 week following uncomplicated cataract surgery: the implication of undiagnosed dry eye disease and topical NSAIDs. Ther Adv Ophthalmol 2019; 11:2515841419869508. [PMID: 31448362 PMCID: PMC6691664 DOI: 10.1177/2515841419869508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/22/2019] [Indexed: 11/17/2022] Open
Abstract
Dry eye disease is a common ocular surface disease in patients who are undergoing cataract surgery. The significance of dry eye disease is often underestimated or overlooked during preoperative assessment of cataract. We report an 80-year-old patient, with a background of seropositive rheumatoid arthritis and diabetes, who presented with an acute corneal melt and perforation associated with undiagnosed dry eye disease and use of topical ketorolac 1 week following an uncomplicated cataract surgery. The patient underwent repeated corneal gluing for corneal perforation and was subsequently diagnosed and treated for bilateral moderate-severe dry eye disease. This case highlights the importance of meticulous preoperative assessment and management of the ocular surface, especially in patients with systemic diseases such as rheumatoid arthritis and diabetes prior to cataract surgery. The implication of the use of topical nonsteroidal anti-inflammatory drugs following cataract surgery - which might have contributed to the process of corneal melt in our case - is also discussed.
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Affiliation(s)
- Darren Shu Jeng Ting
- Sunderland Eye Infirmary, Sunderland, UK; Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
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Surgical Factors Affecting Changes in Ocular Surface Dynamics in the Early Postoperative Period After 25-Gauge Vitrectomy. Eye Contact Lens 2019; 45:254-259. [PMID: 30418296 DOI: 10.1097/icl.0000000000000562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Because vitrectomy-associated postoperative ocular surface changes are not well known, we evaluated such changes before and after vitrectomy in eyes with posterior segment diseases and investigated their associations with patients' characteristics and surgical procedures. METHODS Thirty-five eyes of 32 consecutive patients (16 women; average age 66.6±11.1 years) were included in this prospective, noncomparative case series from tertiary care university hospital. Contact lens wearers and patients with history of ocular surgery or regular use of topical eyedrops were excluded. Patients had undergone primary 25-gauge vitrectomy at Osaka University Hospital in Japan between July and December 2016. Tear break-up time (TBUT), corneal and conjunctival fluorescein staining score (FSS), and tear meniscus height (TMH) were evaluated before, 1 week after, and 1 month after vitrectomy. RESULTS Conjunctival FSS and TMH were significantly higher at 1 week after vitrectomy than preoperatively. However, they decreased significantly 1 month after. Changes in TBUT and corneal FSS showed a similar course at 1 week, but this was not statistically significant. Multiple linear regression analysis showed no significant correlation between significantly increased ocular parameters and patients' characteristics. By contrast, surgical time and combined cataract surgery significantly contributed to increased and decreased conjunctival FSS, respectively (P=0.011 and 0.033, respectively). Sclerotomy site suturing significantly contributed to increased TMH (P=0.025). CONCLUSIONS We showed associations between ocular surface changes and specific surgical procedures. Caution should be exercised to minimize the effect of surgical procedures on the ocular surface during vitrectomy.
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Diabetes and Phacoemulsification Cataract Surgery: Difficulties, Risks and Potential Complications. J Clin Med 2019; 8:jcm8050716. [PMID: 31137510 PMCID: PMC6572121 DOI: 10.3390/jcm8050716] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/08/2019] [Accepted: 05/15/2019] [Indexed: 02/07/2023] Open
Abstract
Diabetes mellitus is one of the most prevalent chronic diseases worldwide. Diabetic patients are at risk of developing cataract and present for surgery at an earlier age than non-diabetics. The aim of this study was to review the problems associated with cataract surgery in a diabetic patient. Corneal complications in diabetic patients include delayed wound healing, risk of developing epithelial defects or recurrent erosions due to the impairment of epithelial basement membranes and epithelial-stromal interactions. Diabetic patients present lower endothelial cell density and their endothelium is more susceptible to trauma associated with cataract surgery. A small pupil is common in diabetic patients making cataract surgery technically challenging. Finally diabetic patients have an increased risk for developing postoperative pseudophakic cystoid macular edema, posterior capsule opacification or endophthalmitis. In patients with pre-proliferative or proliferative diabetic retinopathy, diabetic macular edema or iris neovascularization adjunctive therapy such as an intravitreal anti-vascular endothelial growth factor injection, can inhibit exacerbation related to cataract surgery.
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Impact of 0.1% sodium hyaluronate and 0.2% sodium hyaluronate artificial tears on postoperative discomfort following cataract extraction surgery: a comparative study. EYE AND VISION 2019; 6:6. [PMID: 30805405 PMCID: PMC6373058 DOI: 10.1186/s40662-019-0131-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/27/2019] [Indexed: 12/14/2022]
Abstract
Background Recent artificial tear preparations have provided 0.2% concentration of sodium hyaluronate. However, no published data exist on their potential superiority against 0.1% in alleviating dry-eye-disease symptoms in cataract extraction surgery. Methods A total of 180 patients that underwent cataract extraction surgery were randomly divided into 2 groups according to their postoperative regime: Study group (SG) received fixed combination of tobramycin and dexamethasone (FCTD) quid for 3 weeks, and additionally 0.2% sodium hyaluronate provided in the COMOD® device quid for 6 weeks. Control group (CG) received fixed combination of tobramycin and dexamethasone (FCTD) quid for 3 weeks, and additionally 0.1% sodium hyaluronate provided in the COMOD® device quid for 6 weeks. The following indexes were evaluated at 3 postoperative checkpoints: 1) Surface discomfort index (SDI) which was derived by four direct 10-scale Likert-type questions that were addressed to the patient and pertained to: a) foreign body sensation (FBS), b) blinking discomfort (BD), c) stinging sensation (SS), d) tearing sensation (TS), 2) Tear break-up time (TBUT), 3) Schirmer’s test, 4) Central corneal thickness (CCT), and 4) Central Corneal Sensitivity (CCS). Results Both groups showed reduced CCS values at all postoperative examination points; however, SG participants had significantly better CCS (all p < 0.05). SG had better TBUT than CG at the 3rd (p = 0.03) and 6th examination points (p = 0.04). Moreover, SG had better SDI scores at the 3rd (SDI = 9.26 ± 0.55) and 6th weeks (SDI = 9.47 ± 0.48) vs. CG participants (p = 0.03 and p < 0.01, respectively). Conclusion The increased 0.2% sodium hyaluronate concentration in the artificial tears provided in the COMOD® device seems to address dry-eye-disease symptoms better in patients who underwent phacoemulsification surgery than the 0.1% concentration. Trial registration ClinicalTrials.govIdentifier:NCT03705949 Oct 15, 2018, retrospectively registered.
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Abstract
Diabetes mellitus (DM) has been emerging as one of the most serious health problems worldwide. Ocular complications of DM are currently one of the major causes of blindness in developed countries, among which diabetic retinopathy is relatively well studied and understood. However, although ocular surface complications of DM are common, diabetic complications of anterior segment of the eye, such as, cornea, conjunctiva, and lacrimal glands, are often overlooked. DM is associated with progressive damage to corneal nerves and epithelial cells, which increases the risk of anterior segment disorders including dry eye disease, corneal erosion, persistent epithelial defects, and even sight-threatening corneal ulcer. In this review, the authors will discuss the association of DM with disorders of anterior segment of the eye. Studies indicating the value of corneal nerve assessment as a sensitive, noninvasive, and repeatable biomarker for diabetic neuropathy will also be introduced. In addition, treatment modalities of anterior segment disorders associated with DM is discussed. The studies introduced in this review suggest that early and periodic screening of the anterior segment of the eye, as well as the retina, is important for the optimal treatment of DM.
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Affiliation(s)
- Sang Beom Han
- Department of Ophthalmology, School of Medicine, Kangwon National University, Kangwon National University Hospital, Chuncheon, Korea,
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Kohli P, Arya SK, Raj A, Handa U. Changes in ocular surface status after phacoemulsification in patients with senile cataract. Int Ophthalmol 2018; 39:1345-1353. [PMID: 29926365 DOI: 10.1007/s10792-018-0953-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 06/11/2018] [Indexed: 12/11/2022]
Abstract
AIM To evaluate the signs and symptoms of dry eye after phacoemulsification; effects on the status of ocular surface using impression cytology; and associated risk factors. METHODS Prospective study included 50 eyes (50 patients) with no dry eye signs or symptoms, who underwent clear corneal phacoemulsification for senile cataract. Dry eye indices used included Ocular Surface Disease Index scoring, Schirmer I test, tear break up time, tear meniscus height, corneal fluorescein staining, lissamine green staining and goblet cell density (GCD) with the help of impression cytology. Primary outcome measures included post-operative changes in the dry eye indices. Secondary outcome measures included correlation of the dry eye signs and symptoms with various risk factors. RESULTS Aggravation of both the signs and symptoms of dry eye were noted in immediate post-operative period. The sharp deterioration was followed by a recovering trend towards the end of sixth week. A decrease in GCD was also noted. Risk factors for deterioration include age, duration of exposure to microscope light and effective phacoemulsification time. Diabetic status, socio-economic status and site of incision did not have any effect on dry eye status. CONCLUSION There is a transient deterioration of "dry eye" status post-phacoemulsification. The patients should be carefully counselled about the evanescent nature of the disease. Incision can be given at the site of high corneal curvature to neutralize astigmatism without any fear of inducing dry eye. Minimum light exposure and ultrasound energy should be used during the surgery.
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Affiliation(s)
- Piyush Kohli
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India.
| | - Sudesh Kumar Arya
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Amit Raj
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Uma Handa
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
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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.
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Gomes JAP, Azar DT, Baudouin C, Efron N, Hirayama M, Horwath-Winter J, Kim T, Mehta JS, Messmer EM, Pepose JS, Sangwan VS, Weiner AL, Wilson SE, Wolffsohn JS. TFOS DEWS II iatrogenic report. Ocul Surf 2017; 15:511-538. [PMID: 28736341 DOI: 10.1016/j.jtos.2017.05.004] [Citation(s) in RCA: 251] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 01/04/2023]
Abstract
Dry eye can be caused by a variety of iatrogenic interventions. The increasing number of patients looking for eye care or cosmetic procedures involving the eyes, together with a better understanding of the pathophysiological mechanisms of dry eye disease (DED), have led to the need for a specific report about iatrogenic dry eye within the TFOS DEWS II. Topical medications can cause DED due to their allergic, toxic and immuno-inflammatory effects on the ocular surface. Preservatives, such as benzalkonium chloride, may further aggravate DED. A variety of systemic drugs can also induce DED secondary to multiple mechanisms. Moreover, the use of contact lens induces or is associated with DED. However, one of the most emblematic situations is DED caused by surgical procedures such as corneal refractive surgery as in laser-assisted in situ keratomileusis (LASIK) and keratoplasty due to mechanisms intrinsic to the procedure (i.e. corneal nerve cutting) or even by the use of postoperative topical drugs. Cataract surgery, lid surgeries, botulinum toxin application and cosmetic procedures are also considered risk factors to iatrogenic DED, which can cause patient dissatisfaction, visual disturbance and poor surgical outcomes. This report also presents future directions to address iatrogenic DED, including the need for more in-depth epidemiological studies about the risk factors, development of less toxic medications and preservatives, as well as new techniques for less invasive eye surgeries. Novel research into detection of early dry eye prior to surgeries, efforts to establish appropriate therapeutics and a greater attempt to regulate and oversee medications, preservatives and procedures should be considered.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), São Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | | | - Nathan Efron
- School of Optometry and Vision Science, Queensland University of Technology, Queensland, Australia
| | - Masatoshi Hirayama
- Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan
| | | | - Terry Kim
- Duke University School of Medicine, Durham, NC, USA; Duke University Eye Center, Durham, NC, USA
| | | | - Elisabeth M Messmer
- Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jay S Pepose
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Steven E Wilson
- Cole Eye Institute, The Cleveland Clinic, Cleveland, OH, USA
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Yusufu M, Liu X, Zheng T, Fan F, Xu J, Luo Y. Hydroxypropyl methylcellulose 2% for dry eye prevention during phacoemulsification in senile and diabetic patients. Int Ophthalmol 2017; 38:1261-1273. [PMID: 28699061 DOI: 10.1007/s10792-017-0590-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 06/05/2017] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess the effect of hydroxypropyl methylcellulose (HPMC) 2% to prevent dry eye during phacoemulsification in senile and diabetic patients. METHODS This prospective interventional case series comprised 60 eyes (44 patients) with age-related cataract scheduled for standardized phacoemulsification surgery. The patients were assigned to receive either balanced saline solution (BSS, 30 eyes) or HPMC 2% (30 eyes) during surgery. Preoperative and postoperative examinations (1, 3, 7 and 30 days) included measurements of automatic noninvasive tear film breakup time (NITBUT), fluorescein staining, Schirmer I test, tear meniscus height, depth and area and subjective symptoms. Intraoperative application frequency was also assessed. RESULTS The mean age of patients was 68.7 ± 2.3 years. The application frequency of BSS during surgery was significantly reduced in HPMC group (P = 0.001). The incidence of dry eye syndrome (DES) was significantly reduced in HPMC group in both senile and diabetic patients. Scores of subjective symptoms were significantly higher in the BSS group in 1 day (P = 0.003) and 3 days (P = 0.043) postoperatively. The first and average NITBUT were significantly higher in HPMC group in 1 day and 3 days after surgery, respectively (P = 0.012 and P = 0.024, respectively). NITBUT values did not significantly change postoperatively in the HPMC group (P > 0.05), while they were significantly lower postoperatively in the BSS group. CONCLUSIONS Application of HPMC 2% during phacoemulsification reduced the incidence of DES and improved patients' satisfaction in both senile and diabetic cataract patients. It was also effective in maintaining corneal hydration and was able to significantly reduce the application frequency intraoperatively.
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Affiliation(s)
- Maierhaba Yusufu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, Shanghai, People's Republic of China
- People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, People's Republic of China
| | - Xin Liu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, Shanghai, People's Republic of China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, People's Republic of China
| | - Tianyu Zheng
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, Shanghai, People's Republic of China
| | - Fan Fan
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
| | - Jianjiang Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, Shanghai, People's Republic of China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, People's Republic of China
| | - Yi Luo
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
- Key Laboratory of Myopia of State Health Ministry, Shanghai, People's Republic of China.
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, People's Republic of China.
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Labiris G, Ntonti P, Sideroudi H, Kozobolis V. Impact of polyethylene glycol 400/propylene glycol/hydroxypropyl-guar and 0.1% sodium hyaluronate on postoperative discomfort following cataract extraction surgery: a comparative study. EYE AND VISION 2017; 4:13. [PMID: 28497070 PMCID: PMC5424421 DOI: 10.1186/s40662-017-0079-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/01/2017] [Indexed: 11/25/2022]
Abstract
Background Universal postoperative guidelines for cataract extraction surgery are yet to be introduced. Artificial tears are gaining popularity as an additional integral component of the postoperative regime. The primary objective of this study was to explore the impact of two prevalent artificial tear preparations on postoperative discomfort following cataract extraction surgery. Methods A total of 180 patients that underwent cataract extraction surgery were randomly divided into three groups according to their postoperative regime: a) Study group 1 (SG1) received a fixed combination of tobramycin and dexamethasone (FCTD) quid for 3 weeks and, additionally polyethylene glycol 400/propylene glycol/hydroxypropyl-guar quid, for 6 weeks, b) Study group 2 (SG2) received FCTD quid for 3 weeks and, additionally 0.1% sodium hyaluronate provided in the COMOD® device quid, for 6 weeks, and, c) Control Group (CG) received only FCTD quid for 3 weeks. The following indexes were evaluated at three postoperative checkpoints: 1) Subjective discomfort index (SDI) derived from four direct 10-scale Likert-type questions that were addressed to the patient and pertained to: a) foreign body sensation (FBS), b) blinking discomfort (BD), c) stinging sensation (SS), d) tearing sensation (TS), 2) Tear break-up time (TBUT), 3) Central corneal thickness (CCT) and, 4) Central Corneal Sensitivity (CCS). Results Both groups showed increased CCT values at the first examination point and reduced CCS values at all examination points. Furthermore, both SGs had better TBUT times at all examination points compared to CG (CG: 8.86 ± 1.08, SG1: 9.59 ± 1.45, CG2: 9.45 ± 1.33, p < 0.05). BD was significantly better in both SGs only at the 1st week of examination, while SDI values were better until the 3rd week and only borderline better at 6th week. Lastly, no significant differences were detected between SGs, regarding all parameters, at all examination points. Conclusion Polyethylene glycol 400/propylene glycol/hydroxypropyl-guar and 0.1% sodium hyaluronate provided in the COMOD® device seem to be equally efficient in alleviating OSD symptoms following cataract extraction surgery and any of them should be routinely added to the postoperative regime. Trial registration ClinicalTrials.gov Identifier: https://clinicaltrials.gov/ct2/show/NCT02558218NCT02558218 Electronic supplementary material The online version of this article (doi:10.1186/s40662-017-0079-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Georgios Labiris
- Department of Ophthalmology, University Hospital of Alexandroupolis, 68100 Dragana, Alexandroupolis, Greece.,Eye Institute of Thrace, Alexandroupolis, Greece
| | - Panagiota Ntonti
- Department of Ophthalmology, University Hospital of Alexandroupolis, 68100 Dragana, Alexandroupolis, Greece
| | | | - Vassilios Kozobolis
- Department of Ophthalmology, University Hospital of Alexandroupolis, 68100 Dragana, Alexandroupolis, Greece.,Eye Institute of Thrace, Alexandroupolis, Greece
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