Focus on treating dry eye for patients with cataracts

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According to the results of a retrospective study conducted by Italian researchers, even patients without pre-existing dry eye syndrome (DED) who are due to have cataract surgery may benefit from the perioperative use of artificial tears, especially when starting treatment. preoperatively.

The researchers analyzed data from the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, measurements of tear rupture time (TBUT) and corneal fluorescein staining (CFS) in 3 groups of patients.

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Groups included those who had not used artificial tears during the perioperative period (n = 140); patients who started instilling artificial tears 1 week before the operation and continued for 2 months after the operation (n = 139); and a cohort that used artificial tears postoperatively for 2 months (n = 140).

DED-related assessments were performed preoperatively and during follow-up visits 1, 4, and 8 weeks after surgery.

The artificial tear product was a commercially available lubricant formulation containing hydroxypropylguar and hyaluronic acid, and all patients were treated with the same perioperative regimen of antibiotics and anti-inflammatory drugs.

The results, published in Clinical Ophthalmology,1 showed statistically significant benefits of treatment with artificial tears in alleviating the signs and symptoms of DED induced by surgery.

Statistically significant differences favoring the group that started using artificial tears preoperatively versus the group using eye lubricant only after surgery were observed in analyzes of SPEED and TBUT scores.

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Based on the results, investigators concluded that artificial tears were effective in protecting the ocular surface, especially if they were initiated during the preoperative period.

Noting that SSO can lead to biometric errors and adversely affect patient comfort and vision after surgery, they said the findings underscore the importance of improving ocular surface homeostasis not only in patients with SSO established, but also in those without frank or obvious disease. Risk factors for DED.

Study design
The study identified patients who underwent unilateral cataract surgery in 17 centers in Italy.

A total of 419 patients met the inclusion criteria which required that eligible patients be at least 50 years old and have undergone a simple procedure with a clear corneal incision, IOL implantation in the capsular bag, and postoperative treatment with dexamethasone and tobramycin 4 times a day for 10 days and nepafenac 0.1% 3 times a day for 1 month.

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In addition, patients were required to have data from diagnostic tests for DED performed 30-7 days before surgery and 1, 4, and 8 weeks postoperatively.

Patients were excluded if they had pre-existing DED, diagnosed on the basis of a Schirmer test without anesthesia less than 7 mm / 5 min, TBUT less than 10 seconds, SPEED score greater than 4 and SFC score greater than 1 , or if they had any other finding that could skew the results.

Preoperatively, the 3 study groups were well matched with regard to mean age (~ 72 years), mean Schirmer’s test score (~ 13 mm / 5 min), mean TBUT (~ 12 s) and the percentage of eyes with a CFS score equal to 0 (65% to 76%).

Postoperative data from all groups were consistent with previous reports showing that cataract surgery can induce signs and symptoms of DED.

The mean scores on the SPEED questionnaire did not change significantly in the groups that used artificial tears, but increased significantly (worsened) at week 4 in untreated patients.

The differences in mean SPEED scores were statistically significant in favor of the two groups using artificial tears compared to the untreated group at all follow-up visits.

Investigators noted that 25% of patients in the untreated group had SPEED scores corresponding to symptoms of mild to moderate dry eye at 8 weeks after surgery.

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In addition, a statistically significant difference in favor of the group starting the use of artificial tear preoperatively compared to the group treated only postoperatively was noted at postoperative weeks 1 and 4.

TBUT was significantly higher in both groups using artificial tears compared to controls at all follow-up visits, and mean TBUT fell to less than 10 seconds postoperatively only in the control group.

In addition, TBUT recovered faster in the group using artificial tears preoperatively compared to the group treated only after surgery. At the week 4 postoperative visit, the TBUT was higher in the group that started the use of artificial tears preoperatively compared to the group treated only postoperatively.

The researchers noted that the difference was statistically significant, but that it was not clinically significant.

The results for CFS showed that patients using artificial tears had less corneal damage after surgery than their untreated counterparts.

Among patients who used artificial tears preoperatively and postoperatively, a small minority had CFS scores of 2 (7.2%) or 3 (0.7%) at the week 1 postoperative visit.

In this same group at week 4, more patients had a CFS score of 0 from baseline, and the percentage increased further at week 8.

A similar pattern of early worsening of CFS scores and subsequent progressive improvement was noted in the group that used artificial tears only postoperatively and in the untreated group.

However, among patients who used artificial tears after surgery, around 6% of patients had a CFS score greater than 1 at week 4, while in the untreated group a CFS score greater than 1 was found in 20 % of eyes at week 1, 13% at week 4 and 6.4% at week 8.

Read more by Cheryl Guttman Krader

Reference

1. Favuzza E, Cennamo M, Vicchio L, Giansanti F, Mencucci R. Protecting the ocular surface in cataract surgery: the effectiveness of perioperative use of an ophthalmic solution of hydroxypropyl guar and hyaluronic acid. Clin Ophthalmol. 2020; 14: 1769-1775. doi: 10.2147 / OPTH.S259704


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