Effect Of Manual Small Incision Cataract Surgery On Ocular Surface In Diabetics

To asses the effect of  manual small insicion catarct surgery on the stability of the  tear film  in diabetics
 and non diabetics in the post operative period .

 A comparative hospital based study conducted on 200 eyes of 200 patients  

 A total of 200 eyes of 200 patients ( 100 diabetics and 100  age -sex mateched non diabetics ) above 40 years undergoing manual small incision cataract surgery were included in the study after consent.A tharough medical history  was collected and each participant underwent a complete ophthalmic examination involving visual acuity test, anterior segment evaluation under slit lamp biomicroscopy , fundus examination and tonometry .Ocular symptoms of dry eye was graded according to the level of severity . The tear film and ocular surface were evaluated using Schirmer test, tear film break-up time (TBUT),tear meniscus height and flourescein and  Rose Bengal Staining both pre and post operatively at 1^st week, 3^rd week and 6^th week.

In our study we observed that the symtoms of dry eye were more pronounced in diabetics (63%)compared to non diabetics(28.3%) during the 1 st  & 3 rd post operative week.When compared with non diabetics, diabetics showed significantly reduced Schirmer test values , TBUT measurements and the higher grades of flourescein and  RBS  staining (P < 0.001). Most severe  values were  recorded  at  1st  week post operatively with improvement during  tafter 3 rd & 6 th week  in . Non diabetics showed improvement following 1 week post operatively. Our study  indicates  that  SICS  causes alteration  in  tear  composition which  results  in  unstable  tear film .

Tear film abnormality is a significant feature of diabetic ocular surface diseases.Our study shows that SICS causes alteration in tear film  resulting in a more severe form of dry eye among diabetic patients  compared to non diabetic. Diabetic patients suffer more damage to tear film which is not only due to diabetes but also due to surgery. Post-operative management of dry eye  is crucial in maintaining  tear film homeostasis and to avoid long-term adverse effects of the ocular surface especially in diabetics .