Influences Of Cataract Surgery On Ocular Surface Function

Objective: This paper aims to explore the influences of phacoemulsification and intraocular lens implantation for cataract on ocular surface function.Methods: A prospective, randomized study was carried out on 108 patients with age-related cataract(120 eyes) randomly selected from the outpatient of Hunan People’s Hospital from December 2015 to January2016. Mc Monnies dry eye questionnaire and Keratograph 5M were used to divide these patients into two groups: simple age-related cataract group and age-related cataract accompanied with dry eye group. All of the operations of phacoemulsification combined with intraocular lens implantation were performed by the same experienced physician.Subjective ocular surface disease index(OSDI) questionnaire was used 1day before the operation, 7 day, 30 day and 90 day after the operation.Keratograph 5M was used to record the tear meniscus height, first breakup time of tear film, average breakup time of tear film, deficiency of meibomian glands and scores of corneal fluorescent staining.Results:(1) Questionnaire scores of OSDI: there were statistical significant differences in simple age-related cataract group between preoperative and postoperative 7 day scores(P<0.05). Major postoperative symptom was sensation of foreign body, which was obviously reduced in postoperative30 day and 90 day, but was not obviously different compared with preoperative(P>0.05). In age-related cataract accompanied with dry eyegroup, postoperative 7 day and 30 day scores were both increased(P<0.05) and the sensation of foreign body and irritation were significantly aggravated. However, the symptoms were reduced in postoperative 90 day, without obvious difference compared with preoperative(P>0.05).(2) Noninvasive breakup time of tear film: in both of the two groups, the first breakup time of tear film within postoperative 7 day and average breakup time of tear film were significantly reduced compared with preoperative, with clinical significance(P<0.05). The breakup time of tear film in simple age-related cataract group was still shortened within postoperative 30 day, but not significantly difference compared with preoperative(P>0.05), while the time was recovered to the preoperative level till 90 day in age-related cataract accompanied with dry eye group(P>0.05).(3) Tear meniscus height: in both of the two groups, the tear meniscus height at postoperative 7 day were both decreased, with statistically significant differences(P<0.05). And the tear meniscus height was recovered to preoperative level at postoperative 30 day in the simple agerelated cataract group, which was not obviously different compared with preoperative value(P>0.05). In the age-related cataract accompanied with dry eye group, the tear meniscus height was still decreased in postoperative 30 day(P<0.05), but not obviously different with preoperative value in the postoperative 90 day(P>0.05).(4) Deficiency of meibomian glands: There were no obvious changes in deficiency of meibomian glands in both of the two groups compared with preoperative values, without statistically significant difference(P>0.05).(5) Scores of corneal fluorescein staining: Scores of corneal fluorescein staining were both increased in two groups on postoperative 7 days(P<0.05). And the scores were lower in postoperative 30 day than on postoperative 7 days in simple age-related cataract group, which was basically recovered to preoperative levels(P>0.05). In age-related cataract accompanied with dry eye group, scores of corneal fluorescein staining were significantly increased in postoperative 7 days and 30 day compared with preoperative scores(P<0.05). Postoperative 90 day scores were decreased to preoperative levels, without statistical significance(P>0.05).Conclusions:1. Ultrasound phacoemulsification and intraocular lens implantation for cataract may decrease the stability of tear film in the short term after operation, thus affecting ocular surface function. For patients accompanied with preoperative dry eye, the degree of dry eye will be further aggravated.2. Keratograph 5M can fast, conveniently, accurately and systematically assess the preoperative and postoperative ocular surface and tear film in aged-related cataract patients. which could provide evidences for prevention and treatment for phacoemulsification and intraocular lens dry eyes...