Dry eye disease (DED) is a multifactorial condition that causes symptoms like discomfort, grittiness, foreign body sensation and visual disturbances. It results from decreased tear production or increased evaporation and is especially prevalent in the elderly. According to the International Dry Eye Workshop 2007, is a disease of the tears and ocular surface, characterized by symptoms of discomfort, visual disturbance, and tear film instability, potentially leading to ocular surface damage. This condition is also associated with increased tear film osmolarity and inflammation.

Cataract surgery is a known trigger for exacerbating or inducing DED,confirmed by reduced tear meniscus height and tear breakup time (TBUT), and increases squamous metaplasia on conjunctival impression cytology. This study aims to evaluate the incidence and progression of dry eye in patient’s post-cataract surgery at Khaja Banda Nawaz Teaching Hospital, Kalaburagi.

Objectives: To study the course and evaluate incidence of dry eye in patients post Manual-small incision cataract surgery.

Type of Study: Single centered prospective observational study.

Setting: Department of Ophthalmology, Khaja BandaNawaz Teaching & General Hospital, Kalaburagi.

Duration: December 2018 to June 2020 for a period of one and half year.

Participants: Bilateral senile cataract patients undergoing manual small incision cataract surgery.

Data Collection: Data was collected from blood donor records maintained at the hospital.

Data Analysis: Data were entered in MS-EXCEL and analyzed in SPSS V 22. Descriptive statistics were represented with percentages, mean with SD, Tables. Independent t- test, repeated measures of ANOVA were applied to find significant difference between pre & post for non-normal distribution. Post HOC BONFERONI test used to determine significant difference between two groups. P <0.05 was considered as statistically significant.

Incidence of dry eye on Post op day 7 = 68.18% 

Table 1: Incidence on postop day 7

FIGURES: Gender and Age Distribution

Table 2: Staining pattern of patients studied pre operatively, post operative days 7, 30 and 60

OCULAR STAINING PATTERN

*P value is significant.

In our study it was found that staining pattern was grade 0 preoperatively in all patients which deteriorated to grade 2 in most of the patients i.e. 59.1% on post op day 7 which again improved to grade-0 in 65.5% of patients on post op day 30 and 96.4% of patients on post op day 60. The results were statistically significant (P <0.0001).

 Table 9: Schirmer’s test-I value of patients studied preoperatively, postoperative days 7,30 and 60

SCHIRMER’S TEST-I

POST-HOC-BONFERRONI

In our study it was found that Schirmer’s test-I value was 23.68±4.96 preoperatively which deteriorated to 12.63±4.07 (P<0.0001*) on the postoperative day 7 and 16.22±3.69 (P<0.0001*) and 18.95±3.19(P<0.0001*) on the  postoperative days 30 & 60 respectively. Repeated measures ANOVA test applied for ocular staining group showed statistically significant difference among the groups. (P < 0.0001*).Post-HOC-BONFERRONI test showed statistically significant difference between pre-operative and post-operative days 7, 30 & 60.

Table 10: TBUT value of patients studied preoperatively, postoperative days 7, 30 and 60            

TEAR FILM BREAK UP TIME

POST-HOC-BONFERRONI

In our study it was found that TBUT was 12.42±1.49 preoperatively which deteriorated to 8.12±2.25 (P<0.0001*) on the  postoperative day 7 and 9.8±1.69   (P<0.0001*) and 10.91 ±1.26 ( P<0.0001*) on the postoperative days 30 & 60 respectively.

Repeated measures ANOVA test applied for ocular staining group showed statistically significant difference among the groups (P< 0.0001*).

Post-HOC-BONFERRONI test showed statistically significant difference between pre-operative and post-operative days 7, 30 & 60.

A COMPARATIVE ANALYSIS IN VALUES ON THE 7th , 30th & 60th POSTOPERATIVE  DAYS

POST-HOC-BONFERRONI

SCHIRMER’S TEST-I:

In our study when a comparison in Schirmer’s test is made between postoperative days 7& 30 a mean difference of - 3.591 (p=0.0001*) is seen while between the Postoperative days 7& 60 a mean difference of -6.327 (p=0.0001*).

This shows a statistically significant improvement in the schirmer’s test – I score on the  post-operative days 30 & 60 on comparison with the postoperative day7. However the improvement is more on the post operative day 60.

TEAR FILM BREAK UP TIME:

In our study when a comparison in TBUT is made between postoperative days 7& 30 a mean difference of - 1.682 (p=0.0001*) is seen while between the Postoperative days 7& 60 a mean difference of -2.791 (p=0.0001*).

This shows a statistically significant improvement in the TBUT score on the  post-operative days 30 & 60 on comparison with the postoperative day7. However the improvement is more on the post operative day 60.

Dry eye is a common condition encountered in ophthalmic practice, with age-related etiology being the most prevalent cause. It often results from lacrimal gland dysfunction due to various forms of fibrosis and acinar cell atrophy. A stable tear film is essential for corneal function, and its instability can lead to ocular surface damage, increased tear osmolarity and inflammation.

Cataract, primarily due to aging, overlaps with dry eye conditions. While cataract surgery is successful in improving vision, many patients report discomfort post-surgery, commonly attributed to dry eye. This can be pre-existing or surgically induced, with the latter resulting from corneal nerve denervation during procedures like LASIK or cataract surgery. Differences in incision techniques and locations between surgeries affect corneal innervation differently, impacting dry eye incidence.

Our study at Khaja BandaNawaz Teaching & General Hospital on 110 patients without pre-existing dry eye undergoing cataract surgery, found that 68.18% developed dry eye by post-operative day 7. This aligns with findings from Manjula et al. Gender differences were observed, with 60% of the affected being female, consistent with studies like the Melbourne and Beaver Dam studies, although not universally observed.

The mean age of participants was 64.10 years, highlighting the increased dry eye prevalence in older patients due to reduced tear production and hormonal changes. Pre-operative assessments showed normal ocular staining patterns and adequate tear film metrics, which significantly deteriorated by POD-7.

Comparative studies, such as those by Li XM et al. and Sinha M et al., corroborate these findings, showing significant post-operative reductions in tear film quality and quantity. Factors contributing to this include the use of topical steroids, corneal incisions, and light exposure during procedures.

Post-operative recovery showed improvement by POD-30 and POD-60, although not returning to pre-operative levels, except in ocular staining. This recovery is attributed to reduced steroid use and the application of preservative-free lubricants, enhancing tear stability and reducing inflammation, as supported in a study by Sanchez et al. on Hydroxypropyl-Guar.

In conclusion, while cataract surgery is effective for visual improvement, attention to dry eye management remains crucial for patient comfort and satisfaction.

All the dry eye test values showed deterioration following surgery. It caused significant decrease in TBUT, ST-I values at POD-7, POD-30 and POD-60. Fluorescein staining pattern also showed deterioration in the follow up period. DET parameters reverse to normal level after a sudden declining trend at post operative day 7 & improvement at postoperative day 30. But preoperative levels were not completely reached even after postoperative day 60 for all patients.

The incidence of dry eye on post operative day 7 was 68.18% on the basis of Dry Eye Severity Grading Scheme.

So it is important for ophthalmologists to assess the dry eye in preoperative and postoperative period to ensure proper treatment, for better quality of vision and thereby the quality of life of the patients.

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