.: ORİJİNAL ARAŞTIRMA
Katarakt Cerrahisinin Oküler Yüzey Parametrelerine ve Kuru Göz Gelişimine Etkileri: Prospektif Klinik Çalışma
Effects of Cataract Surgery on Ocular Surface Parameters and Dry Eye Development: Prospective Clinical Study
Turkiye Klinikleri J Ophthalmol. 2024;33(1):46-55
doi: 10.5336/ophthal.2023-100194
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Bu çalışmada, fakoemülsifikasyon cerrahisinin, kuru göz gelişiminde rolü olabilecek çoklu oküler yüzey parametrelerine etkilerini kapsamlı bir şekilde incelemeyi amaçladık. Gereç ve Yöntemler: Cerrahi öncesi kuru gözü olmayan 40 katarakt olgusunun 40 gözü çalışmaya dâhil edildi. Oküler Yüzey Hastalık İndeksi [Ocular Surface Disease Index (OSDİ)] skoru, korneal-konjonktival boyanma dereceleri, Schirmer testi, prekorneal gözyaşı filmi kalınlığı (PrGFK), gözyaşı menisküs yüksekliği (GMY), gözyaşı menisküs derinliği (GMD), gözyaşı kırılma zamanı (GKZ), kapak kenarı anormallik skoru (KKAS), meibum eksprese edilebilirlik skoru (MEES), meibum kalite skoru (MKS) ve meiboskor değerleri; cerrahi öncesi (başlangıçta) ve cerrahi sonrası 1. haftada, 1 ve 3. ayda karşılaştırıldı. OSDİ skoru ≥13, GKZ <10 sn ve Schirmer değeri <10 mm olan olgular kuru göz hastası olarak kabul edildi. Bulgular: Başlangıca kıyasla 1. haftada, 1 ve 3. ayda, OSDİ skorunda (p<0,001) ve korneal-konjonktival boyanma derecelerinde (p<0,05) anlamlı artışlar varken, Schirmer (p<0,001), PrGFK (p<0,001), GMY (p<0,01), GMD (p<0,01) ve GKZ (p<0,001) değerlerinde anlamlı azalışlar vardı. Ancak cerrahi öncesi ve sonrası KKAS, MEES, MKS ve meiboskor değerleri benzerdi (p>0,05). Başlangıca kıyasla cerrahi sonrası 1. haftada, 1 ve 3. ayda kuru göz hastalığı olan olguların sayısı anlamlı arttı (p<0,01). Sonuç: Çalışmamızda fakoemülsifikasyon sonrası OSDİ skoru, korneal-konjonktival boyanma dereceleri, Schirmer testi, PrGFK, GMY, GMD ve GKZ değerleri gibi oküler yüzey parametrelerinin kötüleştiğini, KKAS, MEES, MKS ve meiboskor değerlerinin ise değişmediğini belirledik. Ek olarak cerrahi sonrası kuru gözün erken dönemde geliştiğini ve 3. ayda hâlâ tam düzelmediğini saptadık.
Anahtar Kelimeler: Gözyaşı menisküs derinliği; gözyaşı menisküs yüksekliği; katarakt cerrahisi; kuru göz; meiboskor
Amaç: Bu çalışmada, fakoemülsifikasyon cerrahisinin, kuru göz gelişiminde rolü olabilecek çoklu oküler yüzey parametrelerine etkilerini kapsamlı bir şekilde incelemeyi amaçladık. Gereç ve Yöntemler: Cerrahi öncesi kuru gözü olmayan 40 katarakt olgusunun 40 gözü çalışmaya dâhil edildi. Oküler Yüzey Hastalık İndeksi [Ocular Surface Disease Index (OSDİ)] skoru, korneal-konjonktival boyanma dereceleri, Schirmer testi, prekorneal gözyaşı filmi kalınlığı (PrGFK), gözyaşı menisküs yüksekliği (GMY), gözyaşı menisküs derinliği (GMD), gözyaşı kırılma zamanı (GKZ), kapak kenarı anormallik skoru (KKAS), meibum eksprese edilebilirlik skoru (MEES), meibum kalite skoru (MKS) ve meiboskor değerleri; cerrahi öncesi (başlangıçta) ve cerrahi sonrası 1. haftada, 1 ve 3. ayda karşılaştırıldı. OSDİ skoru ≥13, GKZ <10 sn ve Schirmer değeri <10 mm olan olgular kuru göz hastası olarak kabul edildi. Bulgular: Başlangıca kıyasla 1. haftada, 1 ve 3. ayda, OSDİ skorunda (p<0,001) ve korneal-konjonktival boyanma derecelerinde (p<0,05) anlamlı artışlar varken, Schirmer (p<0,001), PrGFK (p<0,001), GMY (p<0,01), GMD (p<0,01) ve GKZ (p<0,001) değerlerinde anlamlı azalışlar vardı. Ancak cerrahi öncesi ve sonrası KKAS, MEES, MKS ve meiboskor değerleri benzerdi (p>0,05). Başlangıca kıyasla cerrahi sonrası 1. haftada, 1 ve 3. ayda kuru göz hastalığı olan olguların sayısı anlamlı arttı (p<0,01). Sonuç: Çalışmamızda fakoemülsifikasyon sonrası OSDİ skoru, korneal-konjonktival boyanma dereceleri, Schirmer testi, PrGFK, GMY, GMD ve GKZ değerleri gibi oküler yüzey parametrelerinin kötüleştiğini, KKAS, MEES, MKS ve meiboskor değerlerinin ise değişmediğini belirledik. Ek olarak cerrahi sonrası kuru gözün erken dönemde geliştiğini ve 3. ayda hâlâ tam düzelmediğini saptadık.
Anahtar Kelimeler: Gözyaşı menisküs derinliği; gözyaşı menisküs yüksekliği; katarakt cerrahisi; kuru göz; meiboskor
ABSTRACT
Objective: We aimed to investigate comprehensively effects of phacoemulsification surgery on multiple ocular surface parameters that might play a role in dry eye development. Material and Methods: Forty eyes of 40 cataract cases without preoperative dry eye were included in study. Ocular Surface Disease Index (OSDI) score, corneal-conjunctival staining grades, Schirmer test, precorneal tear-film thickness (PrTFT), tear-meniscus height (TMH), tear-meniscus depth (TMD), tear break-up time (TBUT), lid margin abnormality score (LMAS), meibum expressibility score (MES), meibum quality score (MQS), and meiboscore values were compared before surgery (at baseline) and at 1st week, 1st and 3rd month after surgery. Cases with OSDI score ≥13, TBUT<10 seconds and Schirmer value <10 millimeters were accepted as dry eye patient. Results: At 1st week, 1st and 3rd month compared to baseline, there were significant increases in OSDI score (p<0.001) and corneal-conjunctival staining grades (p<0.05), while there were significant decreases in Schirmer (p<0.001), PrTFT (p<0.001), TMH (p<0.01), TMD (p<0.01) and TBUT (p<0.001) values. However, LMAS, MES, MQS and meiboscore values were similar before and after surgery (p>0.05). Compared to baseline, number of cases with dry eye disease increased significantly at 1st week, 1st and 3rd month after surgery (p<0.01). Conclusion: In our study, we determined that ocular surface parameters such as OSDI score, cornealconjunctival staining grades, Schirmer test, PrTFT, TMH, TMD and TBUT values deteriorated after phacoemulsification, while LMAS, MES, MQS and meiboscore values did not change. Additionally, we found that dry eye developed in early period after surgery, and it stil did not fully recover at 3rd month.
Keywords: Tear meniscus depth; tear meniscus height; cataract surgery; dry eye; meiboscore
Objective: We aimed to investigate comprehensively effects of phacoemulsification surgery on multiple ocular surface parameters that might play a role in dry eye development. Material and Methods: Forty eyes of 40 cataract cases without preoperative dry eye were included in study. Ocular Surface Disease Index (OSDI) score, corneal-conjunctival staining grades, Schirmer test, precorneal tear-film thickness (PrTFT), tear-meniscus height (TMH), tear-meniscus depth (TMD), tear break-up time (TBUT), lid margin abnormality score (LMAS), meibum expressibility score (MES), meibum quality score (MQS), and meiboscore values were compared before surgery (at baseline) and at 1st week, 1st and 3rd month after surgery. Cases with OSDI score ≥13, TBUT<10 seconds and Schirmer value <10 millimeters were accepted as dry eye patient. Results: At 1st week, 1st and 3rd month compared to baseline, there were significant increases in OSDI score (p<0.001) and corneal-conjunctival staining grades (p<0.05), while there were significant decreases in Schirmer (p<0.001), PrTFT (p<0.001), TMH (p<0.01), TMD (p<0.01) and TBUT (p<0.001) values. However, LMAS, MES, MQS and meiboscore values were similar before and after surgery (p>0.05). Compared to baseline, number of cases with dry eye disease increased significantly at 1st week, 1st and 3rd month after surgery (p<0.01). Conclusion: In our study, we determined that ocular surface parameters such as OSDI score, cornealconjunctival staining grades, Schirmer test, PrTFT, TMH, TMD and TBUT values deteriorated after phacoemulsification, while LMAS, MES, MQS and meiboscore values did not change. Additionally, we found that dry eye developed in early period after surgery, and it stil did not fully recover at 3rd month.
Keywords: Tear meniscus depth; tear meniscus height; cataract surgery; dry eye; meiboscore
REFERANSLAR:
- Liu YC, Wilkins M, Kim T, Malyugin B, Mehta JS. Cataracts. Lancet. 2017;390(10094):600-12. [Crossref] [PubMed]
- Naderi K, Gormley J, O'Brart D. Cataract surgery and dry eye disease: A review. Eur J Ophthalmol. 2020;30(5):840-55. [Crossref] [PubMed] [PMC]
- Sutu C, Fukuoka H, Afshari NA. Mechanisms and management of dry eye in cataract surgery patients. Curr Opin Ophthalmol. 2016;27(1):24-30. [Crossref] [PubMed]
- Park Y, Hwang HB, Kim HS. Observation of influence of cataract surgery on the ocular surface. PLoS One. 2016;11(10):e0152460. [Crossref] [PubMed] [PMC]
- Khanal S, Tomlinson A, Esakowitz L, Bhatt P, Jones D, Nabili S, et al. Changes in corneal sensitivity and tear physiology after phacoemulsification. Ophthalmic Physiol Opt. 2008;28(2):127-34. [Crossref] [PubMed]
- Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15(3):276-83. [Crossref] [PubMed]
- Bron AJ, de Paiva CS, Chauhan SK, Bonini S, Gabison EE, Jain S, et al. TFOS DEWS II pathophysiology report. Ocul Surf. 2017;15(3):438-510. Erratum in: Ocul Surf. 2019;17(4):842. [Crossref] [PubMed]
- Qian L, Wei W. Identified risk factors for dry eye syndrome: A systematic review and meta-analysis. PLoS One. 2022;17(8):e0271267. [Crossref] [PubMed] [PMC]
- Xue W, Zhu MM, Zhu BJ, Huang JN, Sun Q, Miao YY, et al. Long-term impact of dry eye symptoms on vision-related quality of life after phacoemulsification surgery. Int Ophthalmol. 2019;39(2):419-29. [Crossref] [PubMed]
- Öztürk H, Özen B. The effects of smartphone, tablet and computer overuse on children?s eyes during the COVID-19 pandemic. J Pediatr Res. 2021;8(4):491-7. [Link]
- Li XM, Hu L, Hu J, Wang W. Investigation of dry eye disease and analysis of the pathogenic factors in patients after cataract surgery. Cornea. 2007;26(9 Suppl 1):S16-20. [Crossref] [PubMed]
- Oh T, Jung Y, Chang D, Kim J, Kim H. Changes in the tear film and ocular surface after cataract surgery. Jpn J Ophthalmol. 2012;56(2):113-8. [Crossref] [PubMed]
- Kasetsuwan N, Satitpitakul V, Changul T, Jariyakosol S. Incidence and pattern of dry eye after cataract surgery. PLoS One. 2013;8(11):e78657. [Crossref] [PubMed] [PMC]
- Sahu PK, Das GK, Malik A, Biakthangi L. Dry eye following phacoemulsification surgery and its relation to associated intraoperative risk factors. Middle East Afr J Ophthalmol. 2015;22(4):472-7. [Crossref] [PubMed] [PMC]
- Ishrat S, Nema N, Chandravanshi SCL. Incidence and pattern of dry eye after cataract surgery. Saudi J Ophthalmol. 2019;33(1):34-40. [Crossref] [PubMed] [PMC]
- Kohli P, Arya SK, Raj A, Handa U. Changes in ocular surface status after phacoemulsification in patients with senile cataract. Int Ophthalmol. 2019;39(6):1345-53. [Crossref] [PubMed]
- Wolffsohn JS, Arita R, Chalmers R, Djalilian A, Dogru M, Dumbleton K, et al. TFOS DEWS II Diagnostic Methodology report. Ocul Surf. 2017;15(3):539-74. [Crossref] [PubMed]
- Bron AJ, Evans VE, Smith JA. Grading of corneal and conjunctival staining in the context of other dry eye tests. Cornea. 2003;22(7):640-50. [Crossref] [PubMed]
- Aranha Dos Santos V, Schmetterer L, Gröschl M, Garhofer G, Schmidl D, Kucera M, et al. In vivo tear film thickness measurement and tear film dynamics visualization using spectral domain optical coherence tomography. Opt Express. 2015;23(16):21043-63. [Crossref] [PubMed]
- Park DI, Lew H, Lee SY. Tear meniscus measurement in nasolacrimal duct obstruction patients with Fourier-domain optical coherence tomography: novel three-point capture method. Acta Ophthalmol. 2012;90(8):783-7. [Crossref] [PubMed]
- Li Y, Lu J, Zhou Q, Wang C, Zeng Q, Chen T, et al. Analysis of clinical and regional distribution characteristics of obstructive meibomian gland dysfunction in China: a multicenter study. Curr Eye Res. 2020;45(11):1373-9. [Crossref] [PubMed]
- Napoli PE, Coronella F, Satta GM, Iovino C, Sanna R, Fossarello M. A simple novel technique of infrared meibography by means of spectral-domain optical coherence tomography: a cross-sectional clinical study. PLoS One. 2016;11(10):e0165558. [Crossref] [PubMed] [PMC]
- Jiang D, Xiao X, Fu T, Mashaghi A, Liu Q, Hong J. Transient tear film dysfunction after cataract surgery in diabetic patients. PLoS One. 2016;11(1):e0146752. [Crossref] [PubMed] [PMC]
- Cho YK, Kim MS. Dry eye after cataract surgery and associated intraoperative risk factors. Korean J Ophthalmol. 2009;23(2):65-73. [Crossref] [PubMed] [PMC]
- Noecker R. Effects of common ophthalmic preservatives on ocular health. Adv Ther. 2001;18(5):205-15. [Crossref] [PubMed]
- Kwon JW, Chung YW, Choi JA, La TY, Jee DH, Cho YK. Comparison of postoperative corneal changes between dry eye and non-dry eye in a murine cataract surgery model. Int J Ophthalmol. 2016;9(2):218-24. [PubMed] [PMC]
- Hwang HB, Kim HS. Phototoxic effects of an operating microscope on the ocular surface and tear film. Cornea. 2014;33(1):82-90. [Crossref] [PubMed]
- González-Mesa A, Moreno-Arrones JP, Ferrari D, Teus MA. Role of tear osmolarity in dry eye symptoms after cataract surgery. Am J Ophthalmol. 2016;170:128-32. [Crossref] [PubMed]
- Hanyuda A, Ayaki M, Tsubota K, Negishi K. Discrepancies in persistent dry eye signs and symptoms in bilateral pseudophakic patients. J Clin Med. 2019;8(2):211. [Crossref] [PubMed] [PMC]
- Mencucci R, Ambrosini S, Ponchietti C, Marini M, Vannelli GB, Menchini U. Ultrasound thermal damage to rabbit corneas after simulated phacoemulsification. J Cataract Refract Surg. 2005;31(11):2180-6. [Crossref] [PubMed]
- Kim JS, Lee H, Choi S, Kim EK, Seo KY, Kim TI. Assessment of the tear film lipid layer thickness after cataract surgery. Semin Ophthalmol. 2018;33(2):231-6. [PubMed]
- Han KE, Yoon SC, Ahn JM, Nam SM, Stulting RD, Kim EK, et al. Evaluation of dry eye and meibomian gland dysfunction after cataract surgery. Am J Ophthalmol. 2014;157(6):1144-50.e1. [Crossref] [PubMed]
- El Ameen A, Majzoub S, Vandermeer G, Pisella PJ. Influence of cataract surgery on Meibomian gland dysfunction. J Fr Ophtalmol. 2018;41(5):e173-e80. [Crossref] [PubMed]
- Choi YJ, Park SY, Jun I, Choi M, Seo KY, Kim EK, et al. Perioperative ocular parameters associated with persistent dry eye symptoms after cataract surgery. Cornea. 2018;37(6):734-9. [Crossref] [PubMed]
- Dasgupta S, Gupta R. The course of dry eye following phacoemulsification and manual-SICS: a prospective study based on Indian scenario. Int Eye Sci. 2016;16(10):1789-94. [Link]
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