Epidemiology of persistent post-surgical pain manifesting as dry eye symptoms after cataract surgery

Abstract

Purpose : To evaluate the frequency and risk factors for persistent post-surgical pain (PPP) manifesting as dry eye (DE) symptoms 6 months after surgery

Methods : The single center study population included 119 individuals who had cataract surgery at the Bascom Palmer Eye Institute between January 10, 2016 and January 9, 2017 and had DE symptom information available 6 months after surgery. Patients were divided into 2 groups: PPP group was defined as those with a Dry Eye Questionnaire-5 (DEQ5) score ≥ 6 at six months after cataract surgery while patients without PPP (WPPP) were defined as those with DEQ5 score < 6. As a subgroup, patients with DEQ5 scores ≥ 12 at six months after cataract surgery were defined as having severe PPP.

Results : The mean age of the study population was 73 years, standard deviation 8.0; 55% were female. PPP was present in 34% of individuals, with nearly half experiencing severe PPP. Factors associated with an increased risk of PPP were female gender (odds ratio (OR)=2.68; 95% confidence interval (CI)=1.20-6.00; p=0.01), comorbid autoimmune disorder (OR=13.2; 95% CI=1.53-114; p=0.007), non-ocular chronic pain disorder (OR=4.29; 95% CI=1.01-18.1; p=0.06), antihistamine use (OR=6.22, 95% CI=2.17-17.8; p=0.0003), anti-reflux medication use (OR=2.42; 95% CI=1.04-5.66; p=0.04), antidepressant use (OR=3.17; 95% CI=1.31-7.68; p=0.01), anxiolytic use (OR=3.38; 95% CI=1.11-10.3; p=0.03), and anti-insomnia medication use (OR=5.28; 95% CI=0.98-28.5; p=0.047). PPP patients also reported more frequent use of artificial tears (OR=3.48; 95% CI=2.10-5.79; p<0.0001), higher levels of ocular pain (OR=2.36; 95% CI=1.52-3.67; p<0.0001), and greater symptoms of neuropathic ocular pain (NOP), including burning (OR=3.03; 95% CI 1.31-6.99; p=0.001), wind sensitivity (OR=2.16; 95% CI=1.36-3.43; p=0.001), and light sensitivity (OR=1.44; 95% CI=1.22-1.70; p<0.0001).

Conclusions : PPP in the form of persistent dry eye symptoms is present in approximately 34% of individuals after cataract surgery. The frequency of PPP after cataract surgery is comparable with that of other surgeries including laser refractive surgery (LASIK), dental implants, and genitourinary procedures.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.