Abstract
Purpose: To describe the visual outcomes and complications following cataract surgery in dry eye disease (DED).Methods: This retrospective study included 668 eyes of 399 patients with DED, who underwent cataract surgery between 2011 and 2019 at our multi-tier ophthalmology hospital network. Based on etiology, they were divided into three groups: cicatrizing conjunctivitis (CC), meibomian gland dysfunction (MGD), and Sjogren's syndrome (SS). The data on demographics, visual impairment, surgical technique, visual outcomes, and complications were collected using an electronic medical record system. Median LogMAR best corrected visual acuity (BCVA) with interquartile range (IQR) was compared using Wilcoxon's rank sum test.Results: The median age at which cataract surgery was performed was 58 (IQR: 47–65) years. Etiology of DED was CC in 279, MGD in 255, and SS in 134 eyes. Most (471) eyes underwent phacoemulsification, under peribulbar anesthesia (548) through a temporal clear corneal incision (209) with foldable intraocular lens implantation (417). The overall median LogMAR BCVA improved from 1.1 (IQR: 0.6–2.1) at baseline to 0.3 (IQR: 0.1–0.7) and 0.1 (IQR: 0–0.65) at 1 and 6 weeks (p < 0.0001) post-operatively. The median 6 weeks post-operative BCVA was 0.3, 0.1, and 0.1 in CC, MGD, and SS, respectively, and significantly better than at baseline (p < 0.0001). The leading cause of sub-optimal vision was corneal scarring (44; 9%), and the most common complication was posterior capsular rupture with vitreous loss (23; 3%).Conclusion: Cataract surgery has good visual outcomes in patients with DED, without any disconcerting rate of complications. Pre-existing keratopathy is the main determinant of the extent of post-operative visual recovery.
Highlights
Dry eye disease (DED) comprises a spectrum of disorders which cause tear film instability, hyperosmolarity, chronic inflammation, and neurosensory abnormalities, all of which lead to chronic ocular surface dysfunction [1]
Of the 668 eyes included in the study, CC was the most common cause of DED seen in 279 (41.77%) eyes followed by meibomian gland dysfunction (MGD) and s syndrome (SS), which were seen in 255 (38.17%) and 134 (20.06%) eyes, respectively
Of the 279 eyes with CC, Stevens–Johnson syndrome (SJS) was the leading cause seen in 209 (31.29%) eyes followed by ocular cicatricial pemphigoid (OCP) and graft-versus-host disease (GVHD) in 59 (8.8%) and 1 (0.15%) eye
Summary
Dry eye disease (DED) comprises a spectrum of disorders which cause tear film instability, hyperosmolarity, chronic inflammation, and neurosensory abnormalities, all of which lead to chronic ocular surface dysfunction [1]. It is known to worsen following cataract surgery leading to a higher rate of complications and compromised visual outcomes [3,4,5,6]. This is probably due to increased inflammation, toxicity from eye drops containing preservatives like benzalkonium chloride (BAK), and corneal nerve damage from limbal incisions. Most studies in the existing literature have looked at outcomes of cataract surgery in specific disorders causing severe DED in smaller cohorts [10,11,12]. In the current study, the authors have attempted to study the etiologybased visual outcomes and complications of cataract surgery in a larger cohort of patients with DED
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