Clinical Ophthalmology (Feb 2024)
A Preservative-Free Approach – Effects on Dry Eye Signs and Symptoms After Cataract Surgery
Abstract
Per Jensen,1 Christian Nilsen,1 Morten Gundersen,1 Kjell Gunnar Gundersen,1 Rick Potvin,2 Parisa Gazerani,3 Xiangjun Chen,4– 6 Tor P Utheim,3– 8 Øygunn A Utheim4,7,8 1Ifocus Eye Clinic, Haugesund, Norway; 2Science in Vision, Frisco, TX, USA; 3Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; 4Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; 5Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; 6Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway; 7Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; 8The Norwegian Dry Eye Clinic, Oslo, NorwayCorrespondence: Per Jensen, Ifocus Eye Clinic, Sørhauggata 111, Haugesund, 5527, Norway, Tel +47 906 13 685, Email [email protected]: To compare the effect of treatment with preservative-free dexamethasone, NSAIDs and trehalose/hyaluronic acid eye drops with the preservative benzalkonium chloride containing dexamethasone and NSAIDs after cataract surgery in dry versus non-dry eyes.Patients and Methods: In this prospective randomized intervention study, dry eye tests were performed before and 6 weeks after cataract surgery. Patients were considered as having dry eye, SDE (sign of dry eye), if at least one of the following dry eye tests were abnormal; corneal fluorescein staining (CFS), non-invasive keratograph breakup time (NIKBUT) or tear osmolarity. Patients with SDE were randomly assigned to one of two groups. Group 1 patients were treated with dexamethasone and bromfenac eye drops with the preservative benzalkonium chloride (BAC). Group 2 patients were treated with preservative-free dexamethasone and preservative-free diclofenac, as well as a preservative-free lubricant with trehalose and hyaluronic acid both before and after surgery. Patients with normal tear film status acted as the control group (group 3) and received same treatment as group 1.Results: A total of 215 patients were enrolled six weeks after surgery, the number of patients with SDE decreased significantly in groups 1 and 2 (p < 0.001). Subjective symptoms and objective measures including osmolarity, NIKBUT, CFS, and tear film thickness (TFT) improved after surgery, tear production remained unchanged, while corneal sensitivity and meibomian gland dysfunction (MGD) parameters worsened. In the control group with normal tear-film status, SDE increased significantly after the surgery (p < 0.001). There were no statistically significant differences in tear film parameters between the three groups after surgery.Conclusion: After cataract surgery, patients with mild to moderate dry eyes may experience improved tear film status and reduced symptoms. However, we found no additional beneficial effect on dry eye parameters with treatment with preservative-free dexamethasone, NSAIDs, and lubricants compared to preservative-containing eye drops.Keywords: sign of dry eye, cataract surgery, osmolarity, corneal fluorescein staining, non-invasive keratograph tear break-up time, ocular surface disease index, meibomian gland dysfunction
