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Ashlie Anne Bernhisel, Amy Lin; Tear Film Osmolarity and Matrix Metalloproteinase-9 (MMP-9) Levels after Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4868.
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Dry eye syndrome is a multifactorial eye disease that has a higher incidence in certain populations. Dry eye is traditionally diagnosed based on patient symptoms and clinical exam findings, which include a slit lamp examination and tear production analysis with Schirmer testing. There have been multiple studies that have shown that cataract surgery makes dry eyes worse, at least temporarily. There have been two recent diagnostic tests developed for dry eye which can determine tear osmolarity and matrix matelloproteinase-9 activity. The purpose of this study is to evaluate any correlation between tear osmolarity and MMP-9 activity with traditional dry eye tests and patient symptoms before and after cataract surgery.
This is a prospective, observational study in which patients were enrolled prior to bilateral sequential cataract surgery. The study aim was to enroll 50 patients, with study visits pre-operatively, at 1 month, 3 months, and 6 months after cataract surgery. Dry eye testing was performed in the following sequence: Ocular Surface Disease Index (OSDI) questionnaire, TearLab tear film osmolarity measurement, 5-minute Schirmer test without anesthesia, InflammaDry test, slit lamp examination of eyelid margins, tear film break-up time (TBUT), and corneal fluorescein staining.
12 patients were enrolled over a 2-year period. 12 eyes of 6 patients have complete data collected over the 6-month study period. 24 eyes of 12 patients have between 2 and 4 data points collected. The data shows that all symptoms and objective measurements improved after cataract surgery. When dividing patients with an OSDI score above 50 and those with a score below 50, there was a correlation between higher OSDI scores and low tear break up time. Average TBUT for OSDI scores above 50 were 8.0 seconds at 1 month compared to an average of 12.53 seconds for those with OSDI scores below 50 (p=0.002). At 3 months, patients with OSDI scores greater than 50 continued to have lower TBUT compared to those with OSDI scores less than 50, however this was not statistically significant (p=0.32).
Although dry eye symptoms and tear composition may change or worsen for certain patients after cataract surgery, this data suggests that it may only occur in a small subset of the population. These results suggest further investigation is needed.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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