Dry Eye Epidemiology in Patients before Cataract Surgery

Purpose. To evaluate the prevalence, clinical and pathogenetic variants and statistically significant risk factors of dry eye (DE) in patients before cataract surgery.
Patients and Methods. 600 age-related and complicated cataract patients (70.6 ± 7.8 years old; 269 men, 331 women) were examined. Visometry and biomicroscopy with photographic recording of the lens state and assessment of its opacities according to the LOCS III classification were used to cataract revealing. OSDI testing, lipid interferential test, TBUT, Shirmer-1, -2 tests, visual and OCT meniscometry, evaluation of epitheliopaty and microerosion (with vital staining), compression Norn test in Korb modification, visual and OCT LIPCOF assessment, lid viper epitheliopathy evaluation, anterior segment of the eye photoregistration with computer morphometry were performed to assess the ocular surface condition. The structure of the DE risk factors, was studied both in DE patients and non-DE subjects with calculation of the Pearson xi-square test. To estimate the strength of the connection between the etiological condition and the DE, the normalized value of the Pearson coefficient (C´) was used.
Results. The dry eye prevalence was 53.2 % (of them, 25.5 % was mild, 27.7 % — moderate, by Brzhesky). Subclinical DE prevalence was 27 %. Clinical and pathogenetic variants of mild DE included: isolated lipid deficiency (71.9 %), lipid-mucin deficiency (28.1 %). In patients with moderate DE were identified: aqueous-lipid-mucin deficiency (54.8 %), aqueous-lipid deficiency (37.95 %), isolated aqueous deficiency (7.2 %). The most significant systemic-organ DE risk factors were: diabetes mellitus (C´ = 0.302; in 18.8 % DE patients), female sex (C´ = 0.240; in 62.1 % de patients), allergy (С´ = 0.233; in 23.2 % DE patients). Local risk factors most significantly associated with DE were: meibomian glands dysfunction (С´ = 0.58; in 77.7 % DE patients), chronic blepharitis (С´ = 0.233; in 23.2 % DE patients), pterygium (С´ = 0.276; in 13.2 % DE patients), allergic conjunctivitis (С´ = 0.21; in 21.3 % DE patients). Among the exogenous risk factors, the most significant were: the use of medication affecting tear production or tear film stability (С´ = 0.485; in 89.03 % DE patients), preservative eye drops instillation (С´ = 0.2975; in 56.1 % DE patients).
Conclusion. In our opinion, data on the high DE prevalence in cataract patients (53.2 %) should be taken into account when planning cataract surgery, since perioperative correction of the ocular surface condition can increase the surgical treatment efficiency, predictability and safety. The data on the structure of significant risk factors and clinical and pathogenetic DE variants in cataract patients can be the basis for the development of measures to ensure timely DE detection and implementation of reasonable therapy. The risk factor most significantly associated with DE in cataract patients was the meibomian gland dysfunction (MGD) (Pearson xi-square test = 88.542, p < 0.001, С´ = 0.58; “relatively strong” strength). Considering the modifiability of this risk factor (MGD), as well as its high prevalence (77.7 %), it can be considered that eye lids hygiene may be a reasonable therapy in most DE and cataract patients before phacoemulsification.

1. Berk T.A., Schlenker M.B., Campos-Moller X., Pereira A.M., Ahmed I.K. Visual and refractive outcomes in manual versus femtosecond laser-assisted cataract surgery: a single-centre retrospective cohort analysis of 1838 eyes. Ophthalmology. 2018:6. PII: S0161-6420(17)33311-0. DOI: 10.1016/j.ophtha.2018.01.028

2. Day A.C., Gore D.M., Bunce C., Evans J.R. Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery. Cochrane Database of Systematic Reviews. 2016:Issue 7. Art. No.: CD010735. DOI: 10.1002/14651858.CD010735.pub2

3. Craig J.P., Nelson J.D., Azar D.T., Belmonte C., Bron A.J., Chauhan S.K., et. al. TFOS DEWS II Report Executive Summary. The Ocular Surface: 2017;XXX:1–11. DOI: 10.1016/j.jtos.2017.08.003

4. Сho Y.K., Kim M.S. Dry eye after cataract surgery and associated intraoperative risk factors. Korean J. Ophthalmol. 2009;23(2):65–73. DOI: 10.3341/kjo.2009.23.2.65

5. Yu Y., Hua H., Wu M., Yu Y., Yu W., Lai K., Yao K. Evaluation of dry eye after femtosecond laser-assisted cataract surgery. J. Cataract Refract. Surg. 2015;41(12):2614–2623. DOI: 10.1016/j.jcrs.2015.06.036

6. Stapleton F., Optom M.C., Alves M., Bunya V.Y., Jalbert I., Lekhanont K., Malet F., Na Kyung-Sun, Schaumberg D., Ushino M., Vehof J., Viso E., Vitale S., Jones L., Op- tom F.C. TFOS DEWS II Epidemiology Report. The Ocular Surface. 2017;15:334–365. DOI: 10.1016/j.jtos.2017.05.003

7. Бойко А.А., Дубинкина В.О., Еременко А.И., Куликова О.В., Янченко С.В. Профилактика комбинированного синдрома сухого глаза у пациентов старшей возрастной группы после катарактальной хирургии. Клиническая офтальмология. 2006;3:122–125. [Boyko A.A., Dubinkina V.O., Eremenko A.I., Kulikova O.V., Yanchenko S.V. Prevention of combined dry eye syndrome in patients of older age group after cataract surgery. Clinical ophthalmology = Klinicheskaya Oftalmolodiya. 2006;3:122–125 (In Russ.)].

8. Шпак А.А. Вопросы статистического анализа в российских офтальмологических журналах. Офтальмохирургия. 2016;1:73–77. [Shpak A.A. Issues of the statistical analysis in the Russian ophthalmic journals. The Fyodorov Journal of Ophthalmic Surgery = Oftalmohirurgiya. 2016;1:73–77 (In Russ.)]. DOI: 10.25276/0235-4160-2016-1-73-77

9. Шипилов В.А., Янченко С.В., Сахнов С.Н., Малышев А.В., Эксузян З.А. Фиксатор устройства для получения фотоизображений «глазной поверхности». Современные проблемы науки и образования. 2013;6:689–690. [Shipilov V.A., Yanchenko S.V., Sakhnov S.N., Malyshev A.V., Jeksuzjan Z.A. Latch device for obtaining photos of ocular surface. Modern problems of science and education = Sovremennie problemi nauki I obrazovaniya. 2013;6:689–690 (In Russ.)]. URL: www.science-education.ru/113-11843

10. Янченко С.В., Малышев А.В., Сахнов С.Н., Карапетов Г.Ю. Эффективность и безопасность фармакологического сопровождения катарактальной хирургии у больных глаукомой. Офтальмология. 2018;3:330–338. [Yanchenko S.V., Malishev A.V., Sakhnov S.N., Karapetov G.Yu. Effectiveness and safety of cataract surgery pharmacological support in glaucoma patients. Ophthalmology in Russia = Oftalmologiya. 2018;3:330–338 (In Russ.)]. DOI: 10.18008/1816-5095-2018-1-92-101

11. Bijesterveld O.P. Diagnostic tests in the sicca syndrome. Arch. Ophthalmol. 1969;82:10–14.

12. Korb D.R. The tear film — its role today and in future. In The Tear Film, structure, function and examination. Butterworth — Heimann. 2002:254.

13. Nichols K.N., Foulks G.N., Bron A.J., Glasgow B.J., Dogru M., Tsubota K., Lemp M.A., Sullivan D.A. The International Workshop on Meibomian Gland Dysfunction: Executive Summary IOVS, Special Issue. 2011;52(4):1923–1929. DOI: 10.1167/iovs.10-6997a

14. Сахнов С.Н., Янченко С.В., Малышев А.В. и др. Эпидемиология синдрома «сухого глаза» у пациентов перед рефракционными операциями. Офтальмология. 2018;15(1):92–101. [Sakhnov S.N., Yanchenko S.V., Malyshev A.V., et al. Dry eye epidemiology in patients before refractive operations. Ophthalmology in Russia = Oftalmologiya. 2018;15(1):92–101 (In Russ.)]. DOI: 10.18008/1816-5095-2018-1-92-101

15. Бржеский В.В., Егорова Г.Б., Егоров Е.А. Синдром «сухого глаза» и заболевания глазной поверхности. М.: ГЭОТАР-Медиа. 2016:448. [Brzhesky V.V., Egorova G.B., Egorov E.A. Dry eye and ocular surface diseases. Moscow: GEOTAR-Media; 2016:448 (In Russ.)].

16. Шипилов В.А., Янченко С.В., Сахнов С.Н., Малышев А.В., Каленич Л.А. Применение импульсного неинвазивного ультрафиолетового облучения в терапии изменений глазной поверхности. Кубанский научный медицинский вестник. 2014;4:145–149. [Shipilov V.A., Yanchenko S.V., Sakhnov S.N., Malishev A.V., Kalenich L.A. Application of pulse noninvasive ultraviolet irradiation in therapy of ocular surface changes. Kuban scientific medical bulletin = Kubanskiy nedicinckiy vestnik. 2014;4:145–149 (In Russ.)].

17. Янченко С.В., Малышев А.В., Сахнов С.Н., Федотова Н.В., Орехова О.Ю. Гигиена век в подготовке к лазерной рефракционной хирургии. Вестник офтальмологии. 2016;5:83–88. [Yanchenko S.V., Malyshev A.V., Sakhnov S.N., Fedotova N.V., Orehova O.Y. Eye lid hygiene in chronic allergic blepharoconjunctivitis patients before laser refractive surgery. Annals of Ophthalmology = Vestnik oftal’mologii. 2016;5:83–88 (In Russ.)]. DOI: 10.17116/oftalma2016325

18. Guillon M., Maissa C., Wong S. Symptomatic relief associated with eyelid hygiene in anterior blepharitis and MGD. Eye and contact lens. 2012;38(5):306–312.

19. Peral A., Alonso J., Garsia-Garsia C., Nino-Rueda C., Calvo del Bosque P. Importance of lid hygiene before ocular surgery: qualitative and quantitative analysis of eyelid and conjunctiva microbiota. Eye and contact lens. 2016;42(6):366–370.