Tear substitution therapy optimization of dry eye syndrome and cataract patients

Purpose: to evaluate the effectiveness of approaches to tear substitution in dry eye syndrome (DES) patients before cataract phacoemulsification (CPE). Material and methods. 60 DES and cataract patients who received preoperative therapy — tear substitute instillations (4 times a day, 1 month), were examined before CPE. They were divided into 2 groups each of which was subdivided into two subgroups. Group 1 included 30 mild DES patients with lipid deficiency who had a negative lipid interference test, meibomian gland dysfunction (MGD), and aqua deficiency absence (Schirmer-1 test > 15 mm). The subgroup 1.1 (15 patients) received 0.18 % sodium hyaluronate (SH) instillations (Gilan comfort), while the other subgroup 1.2 received “fat-water” type emulsion instillations. Group 2 consisted of 30 moderate DES patients with lipid-aqua deficiency, who also had negative lipid interference test, MGD, and aqua deficiency presence. Subgroup 2.1 (15 patients) received 0.3 % sodium hyaluronate (SH) instillations (Gilan ultra comfort), while subgroup 2.2 patients received “fat-water” type emulsion instillations. We evaluated: the OSDI points, and tear break-up time (TBUT). Results. As a result of therapy, a positive effect of the therapy on OSDI and TBUT was observed in all subgroups. In group 1 , OSDI decrease and TBUT increase were more pronounced in subgroup 1.1 patients, however, this difference between subgroups was not statistically significant. In group 2, OSDI decrease and TBUT increase were more pronounced and statistically significant in subgroup 2.1 patients. Conclusion. In patients with mild DES and lipid deficiency, 0.18 % SH (Gilan comfort) demonstrated a positive effect on OSDI and TBUT comparable to the “fat-water” type emulsion. In moderate DES patients with lipid-aqua deficiency, 0.3 % SH (Gilan ultra comfort) demonstrated a statistically significant and more pronounced positive effect on OSDI and TBUT than the “fat-water” type emulsion.

1. Craig J.P., Nelson J.D., Azar D.T., et al. TFOS DEWS II Report Executive Summary. Ocular Surface. 2017; 15 (4): 802–12. doi:10.1016/j.jtos.2017.08.003

2. Sakhnov S.N., Yanchenko S.V,, Malyshev A.V., et al. Dry eye epidemiology in patients before cataract surgery. Ophthalmology in Russia. 2020; 17 (2): 281–9 (in Russian). doi: 10.18008/1816-5095-2020-2-281-289

3. 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

4. Stapleton F., Optom M.C., Alves M., et al. TFOS DEWS II Epidemiology Report. Ocular Surface. 2017; 15: 334–65. doi: 10.1016/j.jtos.2017.05.003

5. Yu Y., Hua H., Wu M., et al. Evaluation of dry eye after femtosecond laserassisted cataract surgery. J. Cataract Refract Surg. 2015; 41 (12): 2614–23. doi:0.1016/j.jcrs.2015.06.036

6. Sakhnov S.N., Yanchenko S.V., Malyshev A.V., Karapetov G.Yu. Ocular surface changes after cataract phacoemulsification. Vestnik oftal’mologii. 2021; 137 (6): 55–60 (in Russian). doi:10.17116/ oftalma202113706155

7. Brzhesky V.V., Egorova G.B., Egorov E.A. Dry eye and ocular surface diseases. Moscow: GEOTAR-Media; 2016 (in Russian).

8. Egorov E.A., Alekseev V.N., Astakhov Yu.S., Brzhesky V.V. Rational pharmacotherapy in ophthalmology. Мoscow; 2011 (in Russian).

9. Yanchenko S.V., Malyshev A.V., Sakhnov S.N. The choice of dry eye therapy depending on ocular surface condition. Ophthalmology in Russia. 2021; 18 (2): 346–54 (in Russian). doi:10.18008/1816-5095-2021-2-346-354

10. Bijesterveld O.P. Diagnostic tests in the sicca syndrome. Arch. Ophthalmol. 1969: 82 (1): 10–14. doi: 10.1001/archopht.1969.00990020012003

11. Korb D.R. The Tear Film: structure, function and examination. London: Elsevier Health Sciences; 2002.

12. Lopez Garsia J.S., Garsia Lozano I., Martinez Garchitorena J. Measure of the fatty layer thickness of precorneal tear film by interference colours in different types of dry eye. Arch. Soc. Esp. Oftalmol. 2003; 78 (5): 257-64.

13. Nichols K.N., Foulks G.N., Bron A.J., et al. The International Workshop on Meibomian Gland Dysfunction: Executive Summary IOVS, Special Issue. 2011: 52 (4): 1923–9. doi:10.1167/iovs.10-6997a

14. Shpak A.A. Issues of the statistical analysis in the Russian ophthalmic journals. The Fyodorov Journal of Ophthalmic Surgery. 2016; 1: 73–7 (in Russian). doi:10.25276/0235-4160- 2016-1-73-77

15. Guillon M., Maissa C., Wong S. Symptomatic relief associated with eyelid hygiene in anterior blepharitis and MGD. Eye Contact Lens. 2012; 38 (5): 306–12. doi: 10.1097/ICL.0b013e3182658699

16. 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 Contact Lens. 2016; 42 (6): 366–70. doi: 10.1097/ICL.0000000000000221

17. 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. Vestnik oftal’mologii. 2016; 132 (5): 86–92 (in Russian). doi: 10.17116/ oftalma2016132586-92