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Changes of the Tear Film Lipid Layer Thickness After Cataract Surgery in Patients With Diabetes Mellitus
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Patients with age-related cataract (ARC) and diabetic cataract (DC) were followed to compare the tear film lipid layer thickness (LLT) before and after cataract surgery. Preoperative LLT was comparable in the two groups. However, patients in the DC group had significantly lower preoperative tear break-up time (TBUT) and Schirmer's test results compared with patients in the ARC group. Preoperative LLT correlated with the duration of diabetes in the DC group. There was no difference in LLT in the ARC group before and after surgery. However, the LLT of the DC group was significantly thinner a month after surgery compared with preoperative levels.
- Among patients with DC, the tear film LLT decreases with increasing duration of diabetes and following cataract surgery.
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE
To evaluate changes in the tear film lipid layer thickness (LLT) in cataract patients with diabetes mellitus (DM) after cataract surgery.
METHODS
We recruited consecutive cataract patients and recorded data regarding DM condition. Lipid layer thickness (LLT) and partial blinks rates measured with the LipiView interferometer, tear break-up time (TBUT) and Schirmer's tests, and dry eye symptoms evaluated with the Ocular Surface Disease Index (OSDI) questionnaire were conducted before and one month after cataract surgery.
RESULTS
Finally, 38 age-related cataract (ARC) and 31 diabetic cataract (DC) patients were available for analysis. No significant difference in preoperative LLT and partial blink rates was found between ARC and DC group. However, preoperative TBUT and Schirmer's test results were significantly lower in DC group compared to ARC group (both p < 0.001). DC group showed higher preoperative OSDI score with no significant difference than ARC group (p = 0.279). In DC group, LLT was significantly thinner in cases with longer duration of DM (over 10 years) than in those with shorter duration (p < 0.001). One month after surgery, LLT of DC group was significantly thinner than at baseline (pre: 65.7 ± 23.3, post: 51.3 ± 17.1, p = 0.002). While in ARC group, LLT had no significant difference before and after cataract surgery (pre: 67.1 ± 23.4, post: 60.2 ± 21.1, p = 0.078). Compared to baseline data, there was no statistically significant difference between two groups in the partial blink rates, TBUT and Schirmer's test results after cataract surgery (p > 0.05). Ocular Surface Disease Index (OSDI) scores were significantly higher after surgery than at baseline in both ARC (pre: 8.9 ± 8.4, post: 12.4 ± 8.5, p = 0.003) and DC group (pre: 11.4 ± 10.3, post: 18.5 ± 8.5, p = 0.001). Multivariate linear regression analysis showed OSDI scores were associated with LLT either before or after cataract surgery (β = -0.862, p < 0.001 and β = -0.592, p < 0.001, respectively).
CONCLUSION
The tear film LLT is correlated with duration of DM and becomes significantly thinner one month after cataract surgery, leading to the aggravation of dry eye symptoms.
Additional Info
Disclosure statements are available on the authors' profiles:
Changes of the Tear Film Lipid Layer Thickness After Cataract Surgery in Patients With Diabetes Mellitus
Acta Ophthalmol 2020 Aug 04;[EPub Ahead of Print], K Zhang, S Zhang, J Yu, Y Lu, X ZhuFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Cataract, diabetes, and dry eye are more common with advancing age, such that clinicians will see many patients with diabetes seeking cataract surgery, some of whom may have dry eye. It is important for clinicians to know more about this group of patients, as following cataract surgery, patients with dry eye can be dissatisfied with the results of the surgery due to ocular discomfort.
This study included the use of the LipiView and Ocular Surface Disease Index (OSDI) to assess dry eye. A total of 38 age-related cataract and 31 diabetic patients were compared. After surgery, those with diabetic cataract had a significantly thinner lipid layer (pre, 65.7 ± 23.3; post, 51.3 ± 17.1; P = .002). In the diabetic group the lipid layer thickness was slightly thinner in those with a longer duration of diabetes. All the OSDI scores were significantly higher after surgery.
The clinical implication of these findings is that, prior to cataract surgery, particularly in diabetic patients, evaluation of the lipid layer may highlight patients prone to dry eye symptoms following surgery. Therapeutic interventions could be targeted at improving the lipid layer of the tear film.