The improvement of dry eye after cataract surgery by intraoperative using ophthalmic viscosurgical devices on the surface of cornea

Abstract

Backgroud:This study aimed to investigate the protective effect of intraoperative used hydroxypropyl methylcellulose (HPMC 2%) on the ocular surface after cataract surgery.Methods:A total of 149 eyes (149 patients) diagnosed with age-related cataract, age 69.19 ± 9.74 years, were enrolled in this prospective, parallel-design, continuous, randomised controlled study. Patients were randomly assigned to receive HPMC 2% (study group) or balanced salt solution (control group) during the surgery to moisturize the cornea surface. The Ocular Surface Disease Index, Schirmer test without topical anesthetics, tear break-up time, and corneal fluorescein staining were assessed preoperatively, 1 day, 1 week, and 1 month after the surgery, respectively.Results:The Schirmer test value of male patients in the study group at 1 week postoperation was higher than that of male patients in the control group (P = .019). For patients diagnosed with dry eye before the surgery, Schirmer test value in the male patients in the study group at 1 month after surgery was higher than that in the male patients in the control group (P = .037). Furthermore, for the cluster of preoperative dry eye patients whose surgical time was longer than median, corneal fluorescein staining of the patients in the study group was superior to that of the patients in the control group (P = .032).Conclusion:Intraoperative use of HPMC 2% on the cornea surface could improve clinical outcomes of tear film and ocular surface health to some degree, especially in the patients diagnosed with dry eye before the surgery, male patients, and patients whose surgical time was relatively longer.

Cataract Surgery Destabilises Temporary the Tear Film of the Ocular Surface

“…Since the objective findings do not always correlate with the subjective symptoms, subclinical KCS can be overlooked, which then gets worse after the operation. Previous publications have shown that cataract surgery can worsen existing preoperative KCS [12]. It is therefore important to analyse how the cataract operation itself influences the tear film on the ocular surface.…”

Cataract surgery and dry eye disease: A review

“…As such there is potential for damage to the corneal and conjunctival surface. He et al., 72 in a prospective randomized controlled study (RCT) of 149 patients, compared the intra-operative use of hydroxypropyl methylcellulose (HPMC) 2% or balanced salt solution (BSS) to coat the ocular surface during cataract surgery and documented that when using HPMC 2% intra-operatively, tear film assessment measures (Schirmer I test) and ocular surface health (fluorescein staining) were better in some patient groups, especially those with DED before surgery and patients whose surgical time was protracted. 72 Similarly, Yusufu et al., 73 in a prospective interventional case series of 60 eyes, documented reduced DED symptoms and better TBUT with the intra-operative use of HPMC 2% compared to BSS.…”

“…As discussed above, there are several intra-operative factors that may be important in the pathophysiology of cataract surgery-induced iatrogenic DED including corneal nerve damage secondary to surgical incisions; the potentially toxic effects of povidone-iodine and topical anaesthetic drops on the ocular surface; repeated ocular surface drying/irrigation; phototoxicity; and direct ocular surface trauma. 51 , 55 – 78 , 83 – 85 The cataract surgeon needs to be mindful of these factors when operating on patients, especially when a patient has any pre-existing DED 17 , 18 , 47 , 48 , 97 ( Table 1 ).…”

“…In cases with severe DED, surgeon’s use of the larger incision astigmatic keratotomies/LRIs should be carefully considered in order to limit additional corneal nerve trauma, 61 , 62 and alternatives such as toric intraocular lenses should be considered. The use of a dispersive OVD such as HMPC 2% on the ocular surface during cataract surgery may have protective effects, with prospective randomized and non-randomized studies showing benefits in reduced symptoms and signs of DED post-operatively 72 – 74 and it is the authors’ choice to coat the ocular surface with an OVD in eyes with pre-existing DED during cataract surgery. Finally, to limit post-operative DED it is sensible that the use of any peri-operative topical medications needs to be both appropriate and not excessive, direct ocular surface trauma is kept to a minimum with careful tissue handling, operative light exposure is appropriate for surgical visualization and not excessive, and operative/ocular exposure times are minimized by careful surgical planning.…”

Dry Eye Disease after Cataract Surgery: Study of its Determinants and Risk Factors

“… 6 , 7 , 8 Surgical procedures like cataract surgery cause denervation of the cornea, which results in impaired epithelial wound healing, increased epithelial permeability, decreased epithelial metabolic activity, and loss of cytoskeletal structures associated with cellular adhesion. The incidence of dry eye syndrome among patients undergoing cataract surgery has been shown to be dependent on a host of factors including type of procedure, type of ophthalmic solution being used 9 , intraoperative medication 10 , coexistent systemic disorders 11 , operating microscope light exposure and cumulative dissipated energy (CDE) used during the procedure 12 , and time since surgery. 13 …”