Prevalence of Dry Eyes Following Phacoemulsification Surgery and its Relation to Intraoperative Risk Factor - A One Year Cross Sectional Study at KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi

Abstract

Background and objectives Dry eye is no longer a trivial problem ignored by the eye care professionals. Dry eye is a multi-factorial disease that affects the quality and quantity of tears that alter the ocular surface. After cataract surgery many patients complain of foreign body sensation, irritation, redness, blurring of vision which are considered as unwanted effects of surgery. For patients who experience dry eye after phacoemulsification surgery, vision and quality of life can significantly deteriorate. Increased ocular discomfort after cataract surgery may be a result of failure to diagnose dry eye before or after surgery and/or subsequent inadequate treatment after cataract surgery. The objectives of our study are 1. To study the prevalence of dry eye in patients undergoing phacoemulsification surgery at KLES Dr.Prabhakar Kore Hospital and Medical Research Centre, Belagavi. 2. To analyze dry eye in relation to microscopic light exposure time. Methodology The present study was conducted in the Department of Ophthalmology, KLES Dr.Prabhakar Kore Hospital and Medical Research Centre, Belagavi to study the prevalence of dry eye in patients undergoing phacoemulsification surgery and to analyze dry eye in relation to microscopic light exposure time during the period of 1stJanuary 2017 to 31st December 2017. The study was approved by the Ethical and Research Committee of Jawaharlal Nehru Medical College, Belagavi. Results In our study, out of 100 cases who underwent phacoemulsification, studied for dry eye evaluation, 42% were males and 58% were females, with a M:F ratio of 1:1.4. 68% of the patients were in the age group of 45-59 years and 32% were 60 years and above. In our study, on analysis of Schirmers test-1 at 2 months post-operatively, in the age group of 45-59 years, dry eyes persisted in 13 cases (19.12%) out of the total 68 cases in that group and in the age group 60 years and above, 8 cases (25%) had dry eyes out of the total 32 cases in that group and also on analysis of Tear film breakup time at 2 months post-operatively, in the age group of 45-59 years, dry eyes persisted in 7 cases (21.88%) out of the total 32 cases (32%) in that group and in the age group 60 years and above, 28 cases (41.18%) had dry eyes out of the total 68 cases(68%) in that group. On analysis of Schirmers test-1 , 32% of the cases had dry eye at 1 week post phacoemulsification surgery, 28% at 1 month and 21% at 2 months. Pre-operatively, the mean of the schirmers test values was 19.55 + 8.20 which reduced to 15.70 ± 9.44 at one week post-op which eventually stabilized to 16.71 ± 8.05 at 2 months follow-up. On analysis of Tear film breakup time, 43% of the cases had dry eye at 1 week post phacoemulsification surgery, 47% at 1 month and 35% at 2 months. Pre-operatively, the mean of the TBUT test values was 15.14 ± 4.66 which reduced to 10.76 ± 5.26 at one week post-op, which stabilized till one month follow-up with a mean of 10.97 ± 5.48 and eventually increasing slowly at two months follow-up when the mean was 12.28 ± 5.05. In our study, on analysis of Lissamine green staining, 35% of the cases had dry eye at 1 week post phacoemulsification surgery, 30% at 1 month and 23% at 2 months. In this study on analysis of association between Schirmers test-1 and lissamine green staining at 2 months postoperatively, out of the 65 cases who showed grade-0 lissamine green staining, 6 cases(9.23%) had decreased Schirmers test values, out of the 11 cases who showed grade-I lissamine green staining, 6 cases(54.55%) had decreased Schirmers test values, out of the 8 cases who showed grade-II lissamine green staining, 7 cases(87.50%) had decreased Schirmers test values, and the 2 cases who showed grade-III lissamine green staining, showed decreased Schirmers test values at 2 months. In this study on analysis of association between Tear film breakup time and lissamine green staining at 2 months postoperatively, out of the 77 cases who showed grade-0 lissamine green staining, 18 cases(23.28%) had decreased TBUT test values, out of the 14 cases who showed grade-I lissamine green staining, 9 cases(64.29%) had decreased TBUT test values, out of the 7 cases who showed grade-II lissamine green staining, 6 cases(85.72%) had decreased TBUT test values, and the 2 cases who showed grade-III lissamine green staining, showed decreased TBUT test values at 2 months. In our study, the mean of the MLET values was 22.72+/-3.49 with a minimum value of 13.34 and maximum of 34.90. This study shows a negative correlation between MLET and the dry eye test values which is highly significant(p < 0.001). Conslusions and Interpretations Thus we conclude from this study that Phacoemulsification surgery is indeed capable of inducing dry eye. The values were worse in the early post-operative period which gradually increased over 2 months. Therefore, prior to cataract surgery, patients must be informed about the possible increase in dry eye, however the condition might remain the same in some cases. Intra-operative exposure to microscopic light should be minimized by appropriate use of filters and shortening the exposure time.