.: 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
Ücretsiz Erişim
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
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