Comparison Of Clinical And Inflammatory Markers For Dry Eye Disease Following Phacoemulsification And Manual Small Incision Cataract Surgery
Published 2023 - 41st Congress of the ESCRS
Reference: PO0337 | Type: Free paper | DOI: 10.82333/gb64-bj17
Authors: Hemanth Ramachandar* 1 , Geeta Behera 1 , krishna Ramesh Babu 1 , Medha Rajappa 2 , sachit ganapathy 3
1Ophthalmology,JIPMER,puducherry,India, 2Biochemistry,JIPMER,puducherry,India, 3Biostatistics,JIPMER,puducherry,India
Purpose
To compare clinical [symptom score, Schirmer’s test, tear film break-up time (TBUT), NEI staining score, meibum gland dysfunction (MGD)] and inflammatory markers (Tear IL-1 beta and IL-6 levels) in patients undergoing cataract surgery by phacoemulsification and manual small incision cataract surgery (MSICS)
Setting
The study was conducted in the Departments of Ophthalmology and Biochemistry in a tertiary health care centre in South India.
Methods
Eighty-six (43: MSICS, 43: phacoemulsification) uncomplicated cataract patients > 40 years were recruited. Dry eye evaluation was done preoperatively and at days 1, 21 and 60 after surgery using (1) Ocular Surface Disease Index (OSDI) questionnaire, (2) TBUT, (3) NEI staining score, (4) Schirmer’s I test. MGD was assessed by Lid Margin Score (LMS) and Meibum expressibility score pre-op, day 21 and day 60 post-operatively. Tear fluid IL-1 beta and IL-6 assessment was done at pre-op, post-op day 1, day 21, and day 60.
Results
The OSDI, Schirmer’s, TBUT, NEI scoring and LMS significantly worsened on post-op Day 1, with gradual improvement on Day 21 and Day 60 in both groups. Dry eye disease (DED) as per DEWS-II criteria of OSDI score >13, Schirmer’s <15, TBUT <10s was present in 88.3% and 51.2% patients in the MSICS group, and 37.3% and 25.6% patients of the phacoemulsification group on Day 1 and Day 21 (both, P<0.001), and in 18.7% and 11.7% of the MSICS and phacoemulsification patients, respectively at Day 60 (P=0.082). The IL-1beta and IL-6 levels significantly increased on Day 1, with a gradual return to near pre-op levels on both groups by Day 60. However, IL-1beta levels remained significantly elevated in both groups at Day 60 compared to baseline.
Conclusions
MSICS and phacoemulsification have acute detrimental effects on the ocular surface as evidenced by clinical and inflammatory markers. However, clinical DED is worse with MSICS than phacoemulsification. Hence phacoemulsification may be better in patients with pre-existing DED. Inflammatory markers show persistence even after 2 months, indicating need for mitigation.