PREDICTORS OF TEAR FILM AND OCULAR SURFACE DISRUPTIONS AFTER CATARACT SURGERY: AN EXPLORATORY STUDY

To study the various baseline factors contributing ocular surface damage after uneventful cataract surgery and to develop a plan for rational use of ocular surface protectors before and after cataract surgery

A Prospective non-randomised double masked comparative trial in the Dept. of Cataract services

A Prospective non-randomised double masked comparative trial. Cataracts with and without Diabetes were recruited. Preop evaluation of Meibomian gland morphology and the functional tear film with quantitative non-invasive tear meniscus studies, tear break-up time, blink rate were analyzed & compared with 21 days and 3 months post surgery. Ocular Protection Index (OPI) was calculated as a function of ocular surface health by dividing tear break up time by interblink interval and analyzed each visit. OPI of less than 1.0 is considered as ocular surface damage. Using logistic regression model, effects of age & presence of concomitant DM on ocular surface damage post cataract surgery were studied

200 cases enrolled. Mean OPI was 1.3758 at baseline, 0.9738 at 21 days and 1.1038 at 3 months. Repeated measures ANOVA showed significant time effect (p<0.001). Mean blink interval was 7.91 at baseline & 8.82sec by 21 days. Age adjusted DM influence on meibomian gland loss was 12.1% compared to non-DM 6.64%. The logistic regression model was statistically significant, chi square=11.588, P = 0.003. The model explained 23.6% (Nagelkerke R square) of the variance in treatment response and correctly classified 78.5% of cases. Elderly subjects, diabetics were 6.29 & 1.79 times more likely to sustain surface damages than their younger and non diabetic counterparts respectively

Subjects over 60 years of age, irrespective of concomitant DM had borderline OPI & are susceptible to surface damages post cataract. Subjects with DM irrespective of age had borderline OPI & are likely for damages following cataract. Subjects over 60 years with concomitant DM had suboptimal OPI requiring long-term ocular surface protectors