Ocular Surface & Tear Film Changes in Patients Undergoing Small Incision Cataract Surgery - A Hospital Based Prospective Clinical Study in South Kerala

Abstract

BACKGROUND Dry eye is an important factor affecting the quality of life especially elderly. The major cause of adult blindness in India is cataract. After cataract surgery many are beleaguered by dry eye symptoms. Since small incision cataract surgery remains the most commonly performed surgical procedure for cataract in India the ocular surface and tear film changes occurring in patients after cataract surgery in our hospital was studied. METHODS A prospective observational study was conducted among 120 patients who underwent uncomplicated cataract surgery at RIO, Thiruvananthapuram for a period of 12 months from July 2019 - June 2020 to assess the changes that occur in ocular surface and tear film after small incision cataract surgery. The dry eye status was measured using Schirmer tests, tear film breakup time, tear film height, fluorescein and lissamine green staining and finally graded using OSDI score. The score was assessed preoperatively & postoperatively at 1 week, 4 weeks & 12 weeks. RESULTS Pre & postoperative OSDI score showed that 1 week after surgery only 5 % patients remained with no dry eye changes. 4 weeks after the surgery mild dry eye was found in 35 %, moderate dry eye in 40 % & severe dry eye in 23 % patients. 12 weeks after surgery mild dry eye was found in 53.3 %, moderate in 33.3 % & severe in 1.7 %. The occurrence of dry eye was seen to increase 1wk postoperatively & peak around 4weeks postoperatively. CONCLUSIONS Small incision cataract surgery induces significant dry eye changes in patients whose ocular surface & tear film was normal preoperatively. The dry eye changes were noted to worsen maximum at 4 weeks after surgery & these changes persisted in low grade even at 12 weeks after surgery. KEYWORDS Dry Eyes, Small Incision Cataract Surgery (SICS), OSDI (Ocular Surface Disease Index) Score