An algorithm for the preoperative diagnosis and treatment of ocular surface disorders

Starr, Chauncey; Gupta, Preeya K.; Farid, Marjan; Beckman, Kenneth A.; Chan, Clara C.; Yeu, Elizabeth; Gomes, José Álvaro Pereira; Ayers, Brandon; Berdahl, John P.; Holland, Edward J.; Kim, Terry; Mah, Francis S.

doi:10.1016/j.jcrs.2019.03.023

Cited by 107 publications

(189 citation statements)

References 108 publications

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“…In the annual survey of the American ASCRS, there is consensus that the satisfaction and visual results of operated patients are associated with adequate treatment of the tear film disturbance. Nevertheless, most sur-geons have not taken this problem into account in diagnosis and treatment [11]. Since the objective findings do not always correlate with the subjective symptoms, subclinical KCS can be overlooked, which then gets worse after the operation.…”

Section: Discussionmentioning

confidence: 99%

Cataract Surgery Destabilises Temporary the Tear Film of the Ocular Surface

Cung¹,

Nga²,

Nga³

et al. 2020

Klin Monbl Augenheilkd

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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.

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Section: Discussionmentioning

confidence: 99%

Cataract Surgery Destabilises Temporary the Tear Film of the Ocular Surface

Cung¹,

Nga²,

Nga³

et al. 2020

Klin Monbl Augenheilkd

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“…However, damage to radial corneal stromal nerves inflicted as a result of full-thickness incisional wounds in cataract surgery and subsequent disruption of tear film homeostasis 51 do not appear to be fully appreciated. 55 …”

Section: The Pathophysiology Of Cataract Surgery Associated Dedmentioning

confidence: 99%

“…The incisional damage to corneal nerves in cataract surgery has been known for decades. 55 – 61 Lyne examined 29 eyes undergoing ‘large’ incision cataract surgery and documented complete loss of sensitivity in the sector of cornea enclosed by the arc of the incision in all cases, with only 10% having normal sensitivity at 2 years. 56 John, 57 using a smaller scleral tunnel technique, measured corneal sensitivity in 60 eyes after PCS and reported decreased sensation over the incision width extending in a wedge-shaped sector over one month, which did not encompass the central cornea.…”

Section: The Pathophysiology Of Cataract Surgery Associated Dedmentioning

confidence: 99%

“…A recent questionnaire analysis on dry eyes in cataract and refractive surgery conducted by the American Society of Cataract and Refractive Surgery (ASCRS) indicated that despite clinicians acknowledging the importance of DED management prior to cataract surgery, there was wide variety in treatment practices and clinical opinions. 55 The ASCRS committee therefore devised a pre-operative screening algorithm, including a new pre-operative screening questionnaire (SPEED II), based on the Johnson & Johnson Vision Inc. SPEED questionnaire, and technician-performed, objective, non-invasive, point-of-care clinical diagnostic tests of tear osmolarity and tear film matrix metalloproteinase 9 (MMP-9) levels.…”

Section: Considerations Of the Management Of Cataract Surgery Associamentioning

confidence: 99%

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Cataract surgery and dry eye disease: A review

Naderi

Gormley

O’Brart

2020

European Journal of Ophthalmology

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Aim To review published literature concerning cataract surgery and dry eye disease (DED). Methods A search was undertaken using the following: PubMed (all years), Web of Science (all years), Ovid MEDLINE(R) (1946 to 12 December 2019), Ovid MEDLINE(R) Daily Update 10 December 2019, MEDLINE and MEDLINE non-indexed items, Embase (1974–2019, week 49), Ovid MEDLINE (R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations and Daily (1946 to 12 December 2019), CENTRAL (including Cochrane Eyes and Vision Trials Register; Cochrane Library: Issue 12 of 12 December 2019), metaRegister of Controlled Trials (mRCT) ( www.controlled-trials.com ), ClinicalTrials.gov ( www.clinicaltrial.gov ) and WHO International Clinical Trials Registry Platform ( www.who.int/ictrp/search/en ). Search terms included ‘cataract surgery’, ‘phacoemulsification’ and ‘cataract extraction’, combined with ‘dry eyes’ and ‘ocular surface’. Relevant in-article references not returned in our searches were also considered. Results Publications identified included systematic reviews, meta-analysis, randomized controlled trials, cohort studies, case series and laboratory-based studies. Published data highlighting the burden of DED both prior and following cataract surgery were reviewed as well as studies highlighting the effects of cataract surgery on the ocular surface, intra-operative measures to reduce deleterious effects on the ocular surface and current evidence on the management options of post-operative DED. Conclusions DED is common and can be exacerbated by cataract surgery. Ophthalmologists need to assess for pre-existing DED and instigate treatment before surgery; be aware of reduced accuracy of measurements for surgical planning in the presence of DED; limit intra-operative surgical factors damaging to the ocular surface; and consider management to reduce DED post-operatively.

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“…B. bei refraktiver Chirurgie, UV-Crosslinking bei Keratokonus, phototherapeutischer Keratektomie (PTK) etc. Vor allem auch bei älteren Patienten ist dies sinnvoll im Rahmen einer Kataraktoperation, da postoperativ oft ein Trockenes Auge symptomatisch wird [34].…”

Section: Basistherapie Durch Tränenersatzmittel Und Physikalische Lidunclassified

Entzündung beim Trockenen Auge – Informationen zu Diagnostik und Therapie durch Nutzung der wissenschaftlichen Online-Informationsplattform OSCB-Berlin.org

Knop

2020

Klin Monbl Augenheilkd

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ZusammenfassungDas Trockene Auge gilt als häufigste Erkrankung in der Augenheilkunde. Sein pathophysiologisches Verständnis wurde in den letzten Jahrzehnten durch intensive Forschung wissenschaftlich klinisch und experimentell grundlegend erweitert. Das Spektrum der Erkrankung reicht von einer einfachen bis zu einer schwerwiegenden und komplexen Störung der funktionellen Anatomie der Augenoberfläche mit typischer Disparität zwischen den klinischen Befunden und der Symptomatik des Patienten. Die chronische Verletzung des Gewebes treibt verschiedene selbstverstärkende Regelkreise (vicious circles) an, die insgesamt zur progressiven Verschlimmerung des Krankheitsbildes führen. Dies kann Entzündungsvorgänge auslösen, die zur Entstehung einer immunmodulierten Entzündung und eines chronischen Schmerzsyndroms führen können. Beides ist relativ therapieresistent in der üblichen klinischen Praxis. Ein besserer Einblick in die pathophysiologischen Grundlagen hat viele Ansätze für Neuerungen in Diagnostik und Therapie des Trockenen Auges ermöglicht. Dennoch erfordert die Sicca-Praxis typischerweise hohen Zeitaufwand, bietet im Alltag meist nur symptomatische Therapie und ist oft unbefriedigend für den Patienten und auch für seinen Arzt. Daher erscheint das Trockene Auge nicht selten als ein eher schwer überschaubares und schwieriges Krankheitsbild. Die wissenschaftliche Informationsplattform des Berliner Forschungszentrums für die Augenoberfläche (Ocular Surface Center Berlin, OSCB-Berlin.org) hat sich zum Ziel gesetzt, das Verständnis der funktionellen Interaktionen an der Augenoberfläche zu verbessern und damit auch der Mechanismen bei der komplexen Pathophysiologie des Trockenen Auges und der chronischen Entzündung. Dies ist die Basis für einen aktuellen Überblick über Diagnostik und Therapie des Trockenen Auges auf verschiedenen Ebenen, die ein Verständnis für Kliniker und auch für Patienten erlauben.

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An algorithm for the preoperative diagnosis and treatment of ocular surface disorders

Cited by 107 publications

References 108 publications

Cataract Surgery Destabilises Temporary the Tear Film of the Ocular Surface

Cataract Surgery Destabilises Temporary the Tear Film of the Ocular Surface

Cataract surgery and dry eye disease: A review

Entzündung beim Trockenen Auge – Informationen zu Diagnostik und Therapie durch Nutzung der wissenschaftlichen Online-Informationsplattform OSCB-Berlin.org

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