Persistently Worsened Tear Break-up Time and Keratitis in Unilateral Pseudophakic Eyes after a Long Postoperative Period

Abstract

Dry eye disease may develop and persist after cataract surgery; however, unilateral cases have not been fully documented. This cross-sectional, observational study was conducted in five eye clinics in Japan. A total of 1023 outpatients were initially enrolled, and 89 unilateral pseudophakic subjects with 1+ year of follow-up after uncomplicated cataract surgery were included. The tear break-up times (TBUTs) and keratoconjunctival staining results were compared between phakic and pseudophakic eyes. The mean age of the patients was 69.3 ± 10.4 years (32 men, 36.0%), and the mean postoperative period was 4.6 ± 4.4 (1–20) years. For the ophthalmic parameters, the TBUTs were 4.4 ± 1.9 and 3.8 ± 1.9 s (p < 0.001), the keratoconjunctival staining scores were 0.11 ± 0.38 and 0.22 ± 0.56 (p = 0.02), the spherical equivalents were −1.27 ± 2.51 and −0.99 ± 1.45 D (p = 0.21), the astigmatic errors were 0.79 ± 0.66 and 0.78 ± 0.58 D (p = 0.80), and the intraocular pressures were 13.6 ± 2.9 and 13.5 ± 2.6 mmHg (p = 0.62) for the phakic and pseudophakic eyes, respectively. The corneal status was significantly worse in the pseudophakic eyes than in the contralateral phakic eyes, even after more than one year after implant surgery. The present results suggested that long-term ocular surface problems should be examined further since they may not originate only from surgery or postoperative ocular surface diseases.

Comparable effects on tear film parameters after femtosecond laser-assisted and conventional cataract surgery

“…Cataract surgery is the most common surgery worldwide, and DED is considered a common ocular condition affecting 5-35% of the worldwide [3], expression of inflammatory cytokines [24], prolonged light exposure during surgery, total length of surgery [2], usage of different lid speculums, and the size of corneal incisions [2]. Due to optimized and modern techniques, short surgical time, and individual optimized pre-and postoperative treatments, rates of ocular discomfort and visual disturbance could likely be reduced to a minimum postoperatively [25].…”

“…Cataract surgery is the most common surgery worldwide, and DED is considered a common ocular condition affecting 5–35% of the worldwide population [ 21 ]. After cataract surgery, patients often complain of DED symptoms, which can be a significant cause of vision impairment and reducing patients’ quality of life [ 3 , 14 , 22 , 23 ]. Known factors for postoperative DED symptoms were evaluated over decades, including preoperative subclinical dry eye, disinfection with iodine [ 3 ], expression of inflammatory cytokines [ 24 ], prolonged light exposure during surgery, total length of surgery [ 2 ], usage of different lid speculums, and the size of corneal incisions [ 2 ].…”

“…After cataract surgery, patients often complain of DED symptoms, which can be a significant cause of vision impairment and reducing patients’ quality of life [ 3 , 14 , 22 , 23 ]. Known factors for postoperative DED symptoms were evaluated over decades, including preoperative subclinical dry eye, disinfection with iodine [ 3 ], expression of inflammatory cytokines [ 24 ], prolonged light exposure during surgery, total length of surgery [ 2 ], usage of different lid speculums, and the size of corneal incisions [ 2 ]. Due to optimized and modern techniques, short surgical time, and individual optimized pre- and postoperative treatments, rates of ocular discomfort and visual disturbance could likely be reduced to a minimum postoperatively [ 25 ].…”

“…Dry eye disease (DED) is a common condition in elderly people. Numerous reports were published on tear film alterations after cataract surgery in the past, dealing with subjective symptoms of DED and ocular discomfort within the first 1-3 months after surgery [2][3][4]. Several evaluation techniques exist to diagnose DED.…”

Presbyopia developed earlier during the COVID-19 pandemic

“…After determining the patient’s distance refractive correction, the minimal additional power required to achieve near acuity above 20/25 at 30 cm was measured in 0.25 D increments, and was recorded as near add power. Dry eye-related examinations were performed according to standard procedures [ 22 , 23 ] and consisted of tear break-up time (BUT) and a corneal staining test. BUT was measured using a saline-soaked (with excess flicked off) strip of fluorescein filter paper (Ayumi Pharmaceutical, Tokyo, Japan) applied to the lower lid margin, viewed with a suitable light source and yellow filter.…”