<p>Protecting the Ocular Surface in Cataract Surgery: The Efficacy of the Perioperative Use of a Hydroxypropyl Guar and Hyaluronic Acid Ophthalmic Solution</p>

Abstract

To evaluate the effects of a hydroxypropyl guar (HPG) and hyaluronic acid (HA) ophthalmic solution in terms of post-cataract surgery dry-eye disease (DED) prevention. Patients and Methods: In this retrospective study, the data of 419 patients not previously affected by DED, who had undergone unilateral cataract surgery in 17 Italian centers with different perioperative lubricating regimens, were retrospectively reviewed. Patients who had instilled HPG/HA solution 3 times/day in the preoperative week and for two postoperative months were included in group A; group B only instilled HPG/HA for two postoperative months; group C did not instill any perioperative artificial tears. All patients followed the same antibiotic and anti-inflammatory postoperative topical regimen. The scores of SPEED (Standard Patient Evaluation of Eye Dryness) questionnaire, tear break-up time (BUT) and corneal fluorescein staining (CFS, Oxford scale), performed at the preoperative visit and at one, four and eight postoperative weeks, were evaluated. Results: In groups A and B, the SPEED scores were significantly lower than group C in the whole postoperative period. In group A, the SPEED scores were significantly lower than group B 1 and 4 weeks after surgery (p<0.001 and p=0.021). In group C, 25% of patients reported symptom scores corresponding to mild-moderate dry eye 4 and 8 weeks after surgery. The fluorescein tear BUT in groups A and B was significantly higher than group C in the whole postoperative period (p<0.001). In group A, BUT was significantly higher than group B 4 weeks after surgery (p=0.016). More patients showed no corneal fluorescein staining (CFS grade=0) in groups A and B than group C at all the postoperative visits. Conclusion:The hydroxypropyl guar and hyaluronic acid ophthalmic solution was effective at reducing post-cataract surgery ocular discomfort and tear instability, particularly if also administered in the preoperative period.

Hyaluronic Acid/Trehalose Ophthalmic Solution in Reducing Post-Cataract Surgery Dry Eye Signs and Symptoms: A Prospective, Interventional, Randomized, Open-Label Study

“…Nevertheless, the presence of DED and its risk factors should be investigated preoperatively to avoid postoperative complications [1], thereby optimizing the ocular surface before surgery. A previous study of eyes not affected by preoperative DED [8] showed that a hydroxypropyl guar and the hyaluronic acid ophthalmic solution was effective in reducing post-cataract surgery ocular discomfort and tear instability, with higher BUT and lower symptoms when also administered in the preoperative period. In another multicentric study, the use of a lubricating solution two weeks before cataract surgery, in eyes with either preoperative healthy ocular surface or mild DED [7], had a protective effect against postoperative DED.…”

“…In order to prevent onset or worsening DED after cataract surgery, the presence of DED, and its risk factors, should be investigated preoperatively [1]; optimizing the ocular surface before surgery is not only crucial in at-risk patients but can also be useful for all phacoemulsification candidates [7,8]. Moreover, appropriate intraoperative management-i.e., reducing ocular surface exposure to topical anesthetics and mydriatics, 2 of 9 preservative-containing eye drops, to the light of the microscope and to the ultrasound [9]and tailored postoperative treatment can effectively improve the quality of life of each surgical patient [1].…”

“…The mainstay of post-cataract surgery DED prevention and management is the treatment of Meibomian gland dysfunction (MGD) with non-preserved artificial tears, which has shown good results in terms of the reduction in postoperative DED signs and symptoms in previous clinical studies [1,7,8,[10][11][12]. Thealoz ® Duo formulation (Laboratoires Thea, France) is the combination of a viscosity-enhancing agent, hyaluronic acid (HA) 0.15%, which improves lubrication and prolongs tear retention time on the ocular surface [13,14] and an osmoprotectant agent, trehalose 3%.…”

Applications of Hyaluronic Acid in Ophthalmology and Contact Lenses

“…HA can be used with triglycerides, phospholipids, vitamin B12, coenzyme Q10, hydroxypropyl guar, antibiotics, or steroids. HA used with above compound could increase tear film thickness [ 71 ], improve oxidative stress in the conjunctival epithelium of patients with dry eye [ 72 ], sustains ocular surface [ 73 , 74 ], and reduce DES symptoms [ 67 , 75 , 76 ]. Eye drops containing HA are effective DES pharmaceutical vehicles [ 77 ].…”

Evaluation of Ocular Surface after Cataract Surgery—A Prospective Study

“…One study carried out by Favuzza et al evaluated the effect of a hydroxypropyl guar (HPG) and hyaluronic acid (HA) ophthalmic solution before and during phacoemulsification in terms of post-cataract surgery dry-eye disease (DED) prevention. Patients who had instilled HPG/HA solution three times/day in the preoperative week and for two postoperative months had lower SPEED (Standard Patient Evaluation of Eye Dryness) questionnaire scores and higher tear break-up time scores than the group which only instilled HPG/HA for two postoperative months [ 50 ]. Hovanesian et al determined the effect of topical cyclosporine 0.09% on ocular surface regularity for the patients who were diagnosed with DED before the cataract surgery.…”