Dry Eye

Phacoemulsification Causes Short-term Ocular Surface Impairment

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Phacoemulsification may cause short-term transitory ocular surface impairment, according to a new study published in the European Journal of Ophthalmology.

In the prospective interventional study, 55 eyes of 55 different patients (mean age: 75.75 ± 7.27 years) with no history of dry were included. Patients underwent standard phacoemulsification through a 2.75-mm-wide corneal incision. Tear break-up time, Schirmer test I, and tear meniscus height were measured before standard phacoemulsification and 1 day, 1 week, and 1 month postoperatively. Researchers also documented the ocular surface through photographs, Ocular Surface Disease Index score, and fluorescein staining patterns during these same intervals.

On postoperative day 1, superficial punctate keratopathy had an incidence of 76.3% and patients were divided in to groups with and without development. At 1 week, development was located predominately in the center of the cornea (32.7%) before becoming more frequent in the inferior quadrant (21.8%) at 1 month postoperative.

All dry eye tests were significantly worse after surgery. Ocular Surface Disease Index increased from 10.98 ± 5.05 to 15.87 ± 6.57 at postoperative day 1 (P < 0.001), to 12.80 ± 5.77 at postoperative week 1 (P < 0.001), and to 11.09 ± 4.63 at postoperative month 1 (P = 0.90). On postoperative day 1, fluorescein staining patterns worsened with a score of 2.12. Average break-up time values at 1 day (6.61 ± 2.68), 1 week (6.98 ± 2.79), and 1 month (7.05 ± 2.86) postoperatively were significantly lower than preoperatively (8.78 ± 2.97) (P < 0.001). At 1 month, the mean Schirmer test I value (8.32 ± 3.58) was significantly lower than preoperative value (9.05 ± 3.63) (P < 0.001).

The authors concluded that phacoemulsification may cause short-term transitory ocular surface impairment with superficial punctate keratopathy distribution evolving according to the postoperative time. Patients with altered preoperative values are more likely to develop ocular surface disease and for longer.



Zamorra GM, Caballero EF, Maldonado MJ. Short-term changes in ocular surface signs and symptoms after phacoemulsification. Eur J Ophthalmol. Jan 2020. [Online ahead of print].

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