Cataract Surgery Destabilises Temporary the Tear Film of the Ocular Surface

Abstract

Background Symptoms due to dry eye in the form of keratoconjunctivitis sicca (KCS) are often seen after cataract surgery. We investigated the influence of cataract surgery on tear film stability on the ocular surface.

Material and Methods 60 eyes of 60 patients who underwent cataract surgery were included in a prospective study in 2017 at the Eye Hospital in Hanoi (Vietnam National Institute of Ophthalmology). The mean age of the patients was 65 ± 10 years. The phacoemulsification was performed under topical anaesthesia by a clear corneal incision and implantation of a foldable IOL. The parameters for the evaluation of the change of the tear film included subjective patient data using the Ocular Surface Disease Index questionnaire (OSDI), findings of the Schirmer I test, the tear break-up time (TBUT) as well as the tear meniscus height (TMH) measured noninvasively with the Keratograph 5M (Oculus). In addition, conjunctival and corneal changes were examined after vital staining with fluorescein for the cornea and rose bengal for the conjunctiva. Data were collected preoperatively, at 1 week, 1 month and 3 months postoperatively. According to DEWS, the disease is classified into 4 groups: mild, moderate, severe and very severe.

Results One week after surgery, the total score according to OSDI was significantly increased with a total value of 14.4 ± 4.2 (p = 0.001). Schirmer I was 15.8 ± 4.3 mm preoperatively and decreased significantly in the first postoperative week (p = 0.001), before reaching the preoperative level again after three months. TBUT was 12.6 ± 1.5 s preoperatively, decreased significantly to 9.7 ± 1.5 s during the first postoperative week, and normalized to 12.4 ± 1.3 s by the end of the third month. The meniscus height was 0.245 ± 0.055 mm preoperatively, significantly lowered to 0.229 ± 0.057 mm in the first postoperative period and nearly normalised by the third postoperative month to 0.241 ± 0.051 mm. In the first postoperative week, the rate of mild KCS was observed in 30% of patients. At one month, this decreased to 10% and at three months was no longer demonstrable in any patient.

Conclusion One of three patients experienced mild KCS after cataract surgery. The symptoms lasted up to three months. This should be taken into account preoperatively and appropriate therapy should be planned.

Key words

cornea dry eye disease DED - keratoconjunctivitis sicca - KCS - cornea - cataract surgery

Publication History

Received: 12 February 2020

Accepted: 16 April 2020

Article published online:
13 July 2020

• References/Literatur

• 1 [Anonymous] Report of the TFOS DEWS. Ocul Surf 2007; 5: 65-204
• 2 [Anonymous] Report of the TFOS DEWS II. Available at (Accessed 02.09.2019): http://www.tfosdewsreport.org/report-tfos_dews_ii_report/36_36/en/
• 3 Lemp MA. Report of the National Eye Institute/Industry workshop on clinical trials in dry eyes. CLAO J 1995; 21: 221-232
• 4 Moss SE, Klein R, Klein BE. Incidence of dry eye in an older population. Arch Ophthalmol 2004; 122: 369-373
• 5 Stapleton F, Garrett Q, Chan C, Craig JP. The Epidemiology of dry Eye. In: Chan C. ed. Dry Eye: A practical Approach, Essentials in Ophthalmology, 21. Berlin, Heidelberg: Springer; 2015: 21-29
• 6 Gupta PK, Drinkwater OJ, VanDusen KW. et al. Prevalence of ocular surface dysfunction in patients presenting for cataract surgery evaluation. J Cataract Refract Surg 2018; 44: 1090-1096
• 7 Trattler WB, Majmudar PA, Donnenfeld ED. et al. The Prospective Health Assessment of Cataract Patientsʼ Ocular Surface (PHACO) study: the effect of dry eye. Clin Ophthalmol 2017; 11: 1423-1430
• 8 Liu Z, Luo L, Zhang Z. et al. Tear film changes after phacoemulsification. Zhonghua Yan Ke Za Zhi 2002; 38: 274-277
• 9 Ram J, Gupta A, Brar G. et al. Outcomes of phacoemulsification in patients with dry eye. J Cataract Refract Surg 2002; 28: 1386-1389
• 10 Hanyuda A, Ayaki M, Tsubota K. et al. Discrepancies in persistent dry eye signs and symptoms in bilateral pseudophakic patients. J Clin Med 2019; 8: 211 doi:10.3390/jcm8020211
• 11 Starr CE, Gupta PK, Farid M. et al. ASCRS Cornea Clinical Committee. An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. J Cataract Refract Surg 2019; 45: 669-684
• 12 He Y, Li J, Zhu J. et al. The improvement of dry eye after cataract surgery by intraoperative using ophthalmic viscosurgical devices on the surface of cornea: the results of a consort-compliant randomized controlled trial. Medicine (Baltimore) 2017; 96: e8940 doi:10.1097/MD.0000000000008940
• 13 Schiffman RM, Christianson MD, Jacobsen G. et al. Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol 2000; 118: 615-621
• 14 Sullivan BD, Whitmer D, Nichols KK. et al. An objective approach to dry eye disease severity. Invest Ophthalmol Vis Sci 2010; 51: 6125-6130
• 15 Cetinkaya S, Mestan E, Acir NO. et al. The course of dry eye after phacoemulsification surgery. BMC Ophthalmol 2015; 30: 68 doi:10.1186/s12886-015-0058-3
• 16 Park Y, Hwang HB, Kim HS. Observation of influence of cataract surgery on the ocular surface. PLoS One 2016; 11: e0152460 doi:10.1371/journal.pone.0152460
• 17 Oh T, Jung Y, Chang D. et al. Changes in the tear film and ocular surface after cataract surgery. Jpn J Ophthalmol 2012; 56: 113-118
• 18 Dick HB, Schwenn O, Krummenauer F. et al. Inflammation after sclerocorneal versus clear corneal tunnel phacoemulsification. Ophthalmology 2000; 107: 241-247
• 19 Li XM, Hu L, Hu J. et al. Investigation of dry eye disease and analysis of the pathogenic factors in patients after cataract surgery. Cornea 2007; 26 (9 Suppl. 1): S16-S20
• 20 Kim JR, Oh TH, Kim HS. Effects of benzalkonium chloride on the ocular surface of the rabbit. Jpn J Ophthalmol 2011; 55: 283-293
• 21 Mencucci R, Boccalini C, Caputo R. et al. Effect of a hyaluronic acid and carboxymethylcellulose ophthalmic solution on ocular comfort and tear-film instability after cataract surgery. J Cataract Refract Surg 2015; 41: 1699-1700
• 22 Irvine SR. A newly defined vitreous syndrome following cataract surgery. Am J Ophthalmol 1953; 36: 599-619
• 23 Gass JD, Norton EW. Cystoid macular edema and papilledema following cataract extraction. A fluorescein fundoscopic and angiographic study. Arch Ophthalmol 1966; 76: 646-661
• 24 Jee D, Park M, Lee HJ. et al. Comparison of treatment with preservative-free versus preserved sodium hyaluronate 0.1 % and fluorometholone 0.1 % eyedrops after cataract surgery in patients with preexisting dry-eye syndrome. J Cataract Refract Surg 2015; 41: 756-763
• 25 Chung YW, Oh TH, Chung SK. The effect of topical cyclosporine 0.05 % on dry eye after cataract surgery. Korean J Ophthalmol 2013; 27: 167-171