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Zachary N. Burkhart, Janhavi Modak, Ashley Kingham, Venus Arevalo, Stella K. Kim; Combined Phacoemulsification And Punctal Thermal Cautery Procedures In Patients With Ocular Surface Disease From Cancer Treatment. Invest. Ophthalmol. Vis. Sci. 2012;53(14):583.
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To report combined phacoemulsification and punctal thermal cautery procedures in cancer patients with ocular surface disease at a tertiary cancer center.
IRB-approved retrospective study conducted in patients with severe ocular surface disease undergoing simultaneous cataract surgery and thermal punctal occlusion at MD Anderson Cancer Center between November 2003 and September 2011. Patients' pre and post op. visual acuity, sentinel symptoms, Ocular Surface Disease Index, clinical examination, and presence of adverse events were reviewed. Literature search was conducted for thermal cautery and cataract surgery.
32 combined phacoemulsification and punctal thermal cautery surgeries were performed. Ocular surface disease ranged from ocular graft vs. host disease to post-chemo or radiation severe keratoconjunctivitis sicca. Pre-op, patients were managed with topical and oral medications and punctal plugs, which were often ineffective due to frequent dislodging. Cataract surgery and thermal cautery were performed under sedation, and patients were followed routinely, at 1 day, 1 week and at 1 month. At the one-month post-op visit, there was a statistically significant improvement in the patients’ best corrected visual acuity from a mean LogMAR 0.5911 to LogMAR 0.0339 (p < 0.001). Subjective patient self-assessment using Ocular Surface Disease Index at the one-month post-op visit showed a significant improvement from a mean score of 28.1 to 19.8 (p = 0.009), with nearly 77% of patients reporting improvement in symptoms. Further subjective assessment using the Sentinel Symptom questionnaire revealed a statistically significant improvement in blurred vision (p = 0.0079) as well as dry eye complaints (p= 0.0256). The dry eye sentinel symptom improved from a median score of 8 to 5 post-operatively, with 82% of patients reporting an improvement. No patient had worsening dry eye symptoms post operatively and there were no adverse events (such as endopthalmitis), with median followup of 8 months. Literature search showed no other reports of simultaneous cataract surgery and thermal cautery.
Cataract surgery can worsen dry eye syndrome, leading to suboptimal post-op course with prolonged healing. This report represents the first in the literature to describe simultaneous procedure of cataract surgery and thermal cautery in patients with ocular surface disease, and shows objective and subjective visual and symptomatic improvements known to be associated with the two procedures when performed separately, with no post-operative infection. Combined procedure may benefit patients with cataract and severe ocular surface diseases.
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