Patients’ Satisfaction And Persisting Ocular Surface Symptoms After Cataract Surgery

Ocular surface symptoms, often poorly associated with objective signs, are frequently reported after cataract surgery and may have a relevant impact on overall patients’ satisfaction. The role of neurosensory abnormalities in this context is not fully understood yet.
The aim of this study was to investigate patients' satisfaction, persistent ocular surface symptoms (POSS) and signs, neurosensory abnormalities, and their mutual relationships 6 months after cataract surgery.

Cross-sectional study performed between October and December 2024 at the Eye Clinic of San Giuseppe Hospital (Milan) and of University Hospital of Cagliari.
A review of electronic records identified 300 consecutive patients who had undergone uneventful standard senile cataract surgery (clear corneal incisions, phacoemulsification technique) 6 months prior.
Main exclusion criteria were complicated surgery, potentially painful ocular conditions, and lack of willingness to participate in the study.

300 patients underwent a structured phone interview 6 months after uneventful cataract surgery, investigating their satisfaction and the presence of surgery-related POSS.
22 unsatisfied and 22 satisfied patients, matched for age and sex, were recruited for the CATquest-9SF, Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire 5 (DEQ-5), Symptom Assessment in Dry Eye (SANDE), Best Corrected Visual Acuity (BCVA), Keratograph5M assessment of the ocular surface, fluoresceine break-up time, ocular surface staining (NEI scale), Schirmer test, corneal sensitivity, assessment of light sensitivity (Lumiz 100™), topical anesthetic challenge test and in vivo laser-scanning confocal microscopy of corneal sub-basal nerve plexus (SNP).

Within the 300 patients, 92 (31%) reported POSS (24% of the 262 satisfied vs 77% of the 38 unsatisfied patients; P<0.001).
About hospital-evaluated patients, the 22 unsatisfied patients showed higher OSDI (32.41±18.76 vs 17.72±14.53; P<0.05), DEQ-5 (10.79±5.87 vs 5.05±4.87; P<0.01), and SANDE scores (42.72±29.73 vs 17.53±20.54; P<0.01), lower light (log10[lux]) discomfort thresholds (warm light: 2.88±0.67 vs 3.24±0.83, cold light: 2.71±0.76 vs 3.31±0.83, flashing light: 2.71±0.68 vs 3.29±0.74; P<0.05), higher presence of SNP neuromas (42% vs 10% in the study eye, 37% vs 10% in the controlateral eye; P<0.05) and several other SNP alterations. No differences in BCVA, CATquest-9SF, or tear film and ocular surface exams were observed.

Persistent ocular surface symptoms and neurosensory abnormalities play a crucial role in determining patient satisfaction after cataract surgery.
The differences observed in symptom severity, light sensitivity and sub-basal nerve plexus morphology between satisfied and unsatisfied patients underscore the relevance of neurosensory dysfunction in cataract surgery outcomes. While routine neurosensory assessment is not yet feasible in daily practice, greater awareness of its impact may help refine postoperative management strategies, and improve patient satisfaction.
Further research is needed to explore potential therapeutic interventions targeting neurosensory dysfunction and to improve approaches for mitigating POSS following cataract surgery.