Conjunctival impression cytology as an assessment of ocular surface changes following manual small incision cataract surgery
Abstract
Purpose: To determine the changes inocular surface following manual small incision cataract surgery.
Setting: Department of Ophthalmology, Sri Venkateswara Medical College, Tirupati.
Design: A prospective study
Methods: The study was conducted in 100 eyes of 100 patients. All selected patients without dry eye symptoms preoperatively and who underwent uncomplicated cataract surgery were included in the study. They were studied for tear film breakup time (TBUT), ocular surface staining by Rose Bengal (RB) staining method, and conjunctival impression cytology (CIC) from inferior bulbar conjunctiva. Tests were performed 1 day before and 1wk, 1month and 3months after manual small incision cataract surgery (SICS).
Results: Majority of the study participants were aged between 51- 60 years (51%) with the female predominance. In 8 % of the patients, lower TBUT values were recorded at 3 months postoperative follow up, with statistical significance ( P<0.01). There was a statistically significant difference in ocular surface changes with RB staining between preoperative and postoperative 1 week, 1 month, and 3 months follow up (P<0.002). On CIC, 12%, 49%, 46% of patients showed abnormal grades (grade2 or 3) at 1 week, 1 month, and 3 months postop respectively with a statistically significant value (P < 0.03).
Conclusion: Patients undergoing manual SICS without having dry eye preoperatively, showed changes in ocular surface and tear film stability. Positive test with RB staining and abnormal grading of goblet cells studied by CIC during the postoperative period had shown that compromised ocular surface health after SICS, which can produce dry eye.
Downloads
References
2. Cibis GW. Fundamentals and principles of ophthal-mology. Basic & Clinical Science Course. American Academy of Ophthalmology. Section 2; LEO Publishers; 2004-2005 :309-317.
3. Cho YK, Kim MS. 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. Li XM, Hu L, Hu J, Wang W. Investigation of dry eye disease and analysis of the pathogenic factors in patients after cataract surgery. Cornea. 2007;26 (9 Suppl 1):S16-S20. doi:10.1097/ICO.0b013e31812f67ca
5. Oh T, Jung Y, Chang D, Kim J, Kim H. Changes in the tear film and ocular surface after cataract surgery. Jpn J Ophthalmol. 2012;56(2):113-8. doi: 10.1007/ s10384- 012-0117-8.
6.Murube J, Rivas L. Impression cytology on conjunctiva and cornea in dry eye patients establishes a correlation between squamous metaplasia and dry eye clinical severity. Eur J Ophthalmol. 2003; 13(2):115-127.
7. Nelson JD, Wright JC. Conjunctival goblet cell densities in ocular surface disease. Arch Ophthalmol. 1984;102 (7): 1049-1051.doi: 10.1001/archopht.1984. 01040030851031
8. Chakraborti C, Mukhopadhyay U, Mondal M, Sinha M. Dry eye disease following manual small incision cataract surgery: A study from eastern India. Indian J App Res, 2016;6(8):270-273. doi: 10.15373/2249555x
9. Sinha M, Sinha A, Chowdhury B. Comparative evaluation of dry eye following cataract surgery: a study from north india.IOSR J Dent MedSci.2014;13(6):13-18
10. Srinivasan R, Agarwal V, Suchismitha T, Kavitha. Dry eye after phacoemulsification.AIOC,2008:116-118.
11. Liu Z, Luo L, Zhang Z, Cheng B, Zheng D, Chen W, et al. Tear film changes after phacoemulsification. Zhonghua Yan Ke Za Zhi. 2002;38(5):274-277.
12.Ram J, Gupta A, Brar G, Kaushik S, Gupta A. Outcomes of phacoemulsification inpatients with dry eye. J Cataract Refract Surg. 2002;28(8):1386-1389. doi: https://doi.org/10.1016/S0886-3350(02)01387-1
13. Afsharkhamseh N, Movahedan A, Motahari H, Djalilian AR. Cataract surgery in patients with ocular surface disease: an update in clinical diagnosis and treatment. Saudi J Ophthalmol. 2014;28(3):164-167. doi:10.1016/j.sjopt.2014.06.013.
14. Rizvi Y, Singh S, Dokania A. Comparative assessment of tear function and ocular surface following cataract surgery employing manual SICS and phacoemulsification techniques. Indian J Basic App Med Res. 2014;4(1):544-553.
15. Sahu PK, Das GK, Malik A, Biakthangi L. Dry eye following phacoemulsification surgery and its relation to associated intraoperative risk factors. Middle East Afr J Ophthalmol. 2015; 22(4):472-477. doi: 10.4103/ 0974- 9233.151871
16. Walker TD. Benzalkonium toxicity. Clin Exp Ophthalmol. 2004;32(6):657.DOI:10.1111/j.1442-9071. 2004. 00922.x
17. Khanal S, Tomlinson A, Esakowitz L, Bhatt P, Jones D, Nabili S, et al. Changes in corneal sensitivity and tear physiology after phacoemul-sification. Ophthalmic Physiol Opt. 2008; 28(2):127-134. doi: 10.1111/j.1475-1313.2008.00539.x.
18. Lyne A. Corneal sensitivity after surgery. Trans Ophthalmol Soc UK. 1982;102 (pt 2):302-305.
19. Zabel RW, Mintsioulis G, MacDonald IM, Valberg J, Tuft SJ. Corneal toxic changes after cataract extraction. Can J Ophthalmol. 1989;24(7):311-316.
20. Donnenfeld ED, Solomon K, Perry HD, Doshi SJ, Ehrenhaus M, Solomon R, et al. The effect of hinge position on corneal sensation and dry eye after LASIK. Ophthalmol. 2003;110(5): 1023-1029. doi:10.1016/ S0161 -6420(03)00100-3
21. Kohlhaas M. Corneal sensation after cataract and refractive surgery. J Cataract Refract Surg. 1998;24 (10): 1399-1409. doi: https://doi.org/10.1016/S0886-3350 (98)80237-X
Copyright (c) 2019 Author (s). Published by Siddharth Health Research and Social Welfare Society
This work is licensed under a Creative Commons Attribution 4.0 International License.
OAI - Open Archives Initiative
Therapoid
