Study of Influence of Various Methods of Intraoperative Keratoprotection in Phacoemulsification of Senile Cataract on Morphological and Functional State of Ocular Surface Structures in Late Postoperative Period

Purpose: to study the effect of various methods of intraoperative keratoprotection in phacoemulsification (PE) of senile cataract (SC) on morphological and functional state of the ocular surface structures (OSS) in the late postoperative period.

Patients and methods. 240 patients (240 eyes) who applied for surgical treatment of SC. Age: 65 ± 4 years. 109 men, 131 women. All patients were divided into three observation groups according to the method of intraoperative keratoprotection: 1st group — 60 patients, corneal irrigation with balanced solution; 2nd group — 60 patients, ophthalmic viscosurgical device was applied to the cornea; 3rd group: 3a subgroup — 60 patients, soft contact lens (SCL) was applied to the cornea; subgroup 3b — 60 patients, SCL impregnated with riboflavin solution was applied to the cornea. In addition to the standard ophthalmological examination, Schirmer I test, OCT-scanning were performed, and tear breakup time (TBUT) was determined.

Results. The lowest indicator of Schirmer I test was detected in the 1st group a month after the operation. The indicators did not change 2 months after the operation. There were no significant intergroup differences in the final observation period. The TBUT index in all groups decreased. 3 months after the operation, TBUT in the eyes of 3b subgroup was significantly higher in comparison to other groups. The best state of corneal epithelium thickness (CET) occurred in 3a and 3b subgroups. During the epithelium analysis according to OCT-mapping of the cornea, it was noted that the maximum decrease of CET and the number of defects was detected in the 1st and 2nd groups, and the minimum — in 3a and 3b subgroups at all follow-up periods after surgery. There were no significant intergroup differences in preoperative tear osmolarity. 3 months after surgery, tear osmolarity in patients of 3a and 3b subgroups was significantly lower than in patients of the 1st and 2nd groups. OSDI scores in all groups before surgery were comparable. 3 months after the operation, the minimum OSDI values were 3a and 3b in subgroups. Iatrogenic dry eye syndrome (DES) in patients of 3b subgroup was significantly lower than in patients of other groups.

Conclusion. In all the studied groups, the standard postoperative dynamics of OSS and TBUT and changes in CET were revealed, with the least variability in 3b subgroup. The use of SCL saturated with riboflavin showed the highest keratoprotective efficacy in PE SC, as it allowed a statistically significant reduction in the incidence of DES in patients after PE in SC (p < 0.05) in comparison with other methods. The developed method for predicting iatrogenic DES in patients after PE in SC is highly informative, because the number of patients in the 1st group with DES was within the expected range of error.

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