Eyeworld

EW RESIDENTS 60 December 2015 by Anton M. Kolomeyer, MD, PhD, Shilpa M. Kodati, MD, John S. Swogger, DO, Colin J. Prensky, MD, Benjamin R. Strauss, MD, Alex Mammen, MD, and Evan "Jake" Waxman, MD, PhD, UPMC Eye Center, University of Pittsburgh School of Medicine Yinhui and colleagues evaluated the effects of femtosecond laser-as- sisted cataract surgery (FLACS) ver- sus manual phacoemulsification cat- aract surgery (PCS) on dry eye in the immediate 1-month postoperative period. In this nonrandomized, pro- spective comparative cohort study of 137 eyes of 137 patients, a total of 73 patients underwent FLACS and 64 patients underwent PCS. The demographics of the patients within each surgical group were similar. A single surgeon performed all of the surgeries; however, no parameters were given to define who would ulti- mately undergo FLACS versus PCS. The inclusion criteria were patients aged 40 years or older with T he technique of cataract surgery has continued to evolve over the last several decades. From intracap- sular cataract extraction (ICCE) to manual phacoemulsifica- tion cataract surgery (PCS), cataract extraction has not only improved patients' vision but also their quality of life. Currently, the introduc- tion of femtosecond laser-assisted cataract surgery (FLACS) is further progressing the technique of cataract extraction. The procedure is being lauded for its ability to create an accurate clear corneal incision and anterior capsulorhexis, in addition to lens fragmentation to reduce phacoemulsification energy. Despite modern advances in technology, preoperative evaluation remains a crucial component of any procedure. Cataract surgery requires a thorough assessment of the tear film and ocular surface for evidence of dry eye syndrome. Prior studies have demonstrated that PCS can exacerbate dry eyes. Patients have endorsed more subjective symptoms of dry eyes such as discomfort and fatigue, and ophthalmologists also note decreased tear break-up time and meibomian gland dysfunction leading to tear film instability. 1 The prevalence of both cataracts and dry eye syndrome increases with age. According to the National Eye Institute, the number of individu- als diagnosed with cataracts in the United States was 24.4 million in 2010. Due to the aging population, the total number is expected to reach 50 million in 2050. Dry eye di- agnosis among men and women in the United States increases with age, affecting more than 7% of men over the age of 80 years and 9% of wom- en over the age of 75 years. 2,3 Dry eye symptoms have been associated with lower quality of life, affecting a patient's ability to perform activities of daily living, their emotional well being, and work productivity. 4 To date, no current study has evaluat- ed the effects of FLACS on dry eye symptoms in the postoperative pe- riod. Prior studies evaluating goblet cell density following femtosecond laser application during LASIK have shown a reduction in density, poten- tially contributing to ocular surface disease following LASIK procedures. 5 Review of "Evaluation of dry eye after femtosecond laser-assisted cataract surgery: Evaluation of dry eye after femtosecond laser-assisted cataract surgery: a prospective study Yinhui Yu, MD, Huixia Hua, MS, Menghan Wu, MS, Yibo Yu, MD, Wangshu Yu, MS, Kairan Lai, PhD, Ke Yao, MD J Cataract Refract Surg (Dec) 2015;41. Article in press Purpose: To evaluate dry eye signs and symptoms in patients who underwent femtosecond laser-assisted cataract surgery (FLACS) and those with phacoemulsification cataract surgery (PCS). Setting: Eye Center of the 2nd Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China Design: Prospective consecutive nonrandomized comparative cohort study Methods: Consecutive patients who had FLACS or PCS were assessed. Dry eye markers including Ocular Surface Disease Index (OSDI) and subjective symptom questionnaire, tear film assessment using Keratograph 4, Schirmer testing I (STI), and fluorescein staining (FI) were sequentially evaluated preoperatively and postoperatively at 1 day, 1 week, and 1 month. Results: 137 eyes from 137 patients were recruited. Baseline characteristics were well balanced. Evaluations indicated that most patients developed dry eye postoperatively. Subjective symptoms and FI scores elevated from baseline, tear break-up time and STI values decreased postoperatively, which peaked at 1 week and did not return to baseline within 1 month. There were no significant differences between the 2 groups (all P>0.05) except that the laser group was associated with a higher FI score at 1 day (P=0.001), 1 week (P=0.047), and 1 month (P=0.025). OSDI score and subjective symptoms were greater in the laser group at 1 week (P=0.014 and P=0.016, respectively). When conducting subgroup analysis, obvious aggravation was also observed by FI at 1 day (P=0.016) and 1 month (P=0.009) in pre-surgical dry eye patients. Conclusions: Both FLACS and PCS would aggravate dry eye postoperatively. FLACS resulted in higher risk of staining and dry eye symptoms. Furthermore, pre-existing dry eye patients who underwent FLACS had more severe ocular surface staining than those with PCS. Dry eye is a frustrating cause of patient dissatisfaction following cataract or keratorefractive surgery. Which techniques are more likely to cause dry eye? This month, I asked the Pittsburgh residents to review two papers from the December JCRS issue that seek to answer these questions. –David F. Chang, MD, EyeWorld journal club editor Evan "Jake" Waxman, MD, PhD, program director, UPMC Eye Center, University of Pittsburgh School of Medicine Alex Mammen, MD, associate program director, UPMC Eye Center, University of Pittsburgh School of Medicine age-related cataract. The exclusion criteria were any factor that could negatively affect the tear film, which included prior history of trauma and/or surgery; known ocular pathology; diagnosis of selected systemic illnesses including diabetes, thyroid eye disease, and systemic lupus erythematous, among others; use of selected topical eye drops including artificial tears; inability to undergo FLACS due to prior ocular conditions such as poor dilation, conjunctivochalasis, and a function- ing bleb, among others; women who may be pregnant; known medica- tion sensitivities; current participa- tion in another clinical trial; and poor compliance with follow-up or EyeWorld journal club

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