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Edoardo Villani, Luca Marelli, Stefano Lucentini, Edoardo Ruggiero, Paolo Nucci; The Ocular Surface Frailty Index as a predictor of dry eye onset after cataract surgery. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6776.
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Cataract surgery has been shown to lead to development or worsening of dry eye symptoms, with dry eye being a major complaint in the post-operative period. The identification of healthy subjects more susceptible to develop this problem is still an unmet need. We performed a single-centre, observational, longitudinal, prospective study to build a new Ocular Surface Frailty Index (OSFI) and to assess its predictive value for Dry Eye Disease (DED) onset after cataract surgery.
We screened 405 consecutive patients scheduled for phacoemulsification for age-related cataract at the Eye Clinic of San Giuseppe Hospital of Milan. Exclusion criteria were pre-operative DED or other ocular surface diseases and lack of willingness or ability to participate in the study. 303 eyes of 303 patients fulfilling the above criteria who underwent uneventful cataract surgery with posterior chamber monofocal IOL implantation were included in the final analysis. Borrowing a concept from general and geriatric surgery and following a previously validated and published procedure, we built a new OSFI, including 20 anamnestic and clinical items (“deficits in health”). Pre-operative OSFI was calculated for each enrolled patient and diagnostic tests for DED were performed (following the TFOS DEWS II recommendations) at the screening visit and 1 week (V1) and 1 month (V2) after surgery. We evaluated the association between the pre-operative OSFI and the onset of DED within V2.
The median pre-operative OSFI score was 216.00, ranging from 0 to 483. We identified 3 categories based on the OSFI score: mild frailty (OSFI ranging from 0 to 161; n=66), moderate frailty (OSFI ranging from 162 to 322; n=212), severe frailty (OSFI over 323; n=25). The cumulative percentage of patients with DED onset within V2 was 16.2%. DED onset rate significantly increased from 10.2% to 38.1% from the lowest to the highest frailty category (P<0.01; linear by linear trend test). In a multivariable logistic regression model, OSFI (but not age and gender) showed to be significantly associated with post-operative DED onset (odds ratio=2.279; 95%CI).
The OSFI can be easily and quickly calculated using non-invasive and low-tech procedures and it showed to be predictive of post-operative DED onset. This novel tool might allow cataract surgeons to perform a useful pre-operative personalized risk assessment.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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