Controlling Dry Eye Disease After Femtosecond Laser Cataract Surgery Using Topical Lubricants: A Double-Blind Randomized Control Trial

The primary and the secondary objective was to study the effects of topical lubricants on post-operative dry eye disease after FLACS and on tear inflammatory markers.

The study is conducted in outdoor patient department of Ophthalmology in All India Institute of Medical Sciences, New Delhi. It was a prospective double blind randomized control trial. The study included all patients who underwent FLACS.

The study included 20 eyes of 16 patients; 10 eyes were randomized to the treatment group that received topical lubricants (carboxymethylcellulose 0.5% and hyaluronic acid 0.1%), and 10 eyes were randomized to the placebo group that received placebo (0.9% normal saline). Both groups received standard preoperative topical medications. These were prescribed 3 days before the FLACS and were continued till 1 month post-operatively. OSDI, Clinical picture, and dry eye tests (TBUT, Schirmer I test, NEI scoring) were recorded preoperatively and postoperatively on all follow-ups. Ocular surface analyzer (lipid layer type, NIBUT, TMH, and meibography) and tear inflammatory markers were measured preoperatively and 1 month postoperatively.

Compared to the placebo group, the treatment group showed significantly lesser increment in OSDI and NEI scores postoperatively, on all follow-ups for OSDI and on 1 week, 1 month, and 3 months follow-up for NEI scores. The treatment group showed a lesser reduction in postoperative TBUT and NIBUT compared to the placebo group, which was significant on 1 month and 3 months follow-up. There was a non-significant increase in TNF α levels in tear samples of the placebo groups at 1 month when compared to the treatment group. There was no significant difference between the treatment and placebo groups in Schirmer I test values, TMH, Lipid layer thickness, meibomian gland loss, IL-1β levels in the tear, and grade of redness.

The study demonstrated that the postoperative ocular surface damage and tear film instability associated with the FLACS procedure are real and substantial. Symptoms and signs of dry eye disease can be significantly ameliorated by the use of perioperative topical lubricants.