Analysis of Risk Factors of Postoperative Dry Eye in Cataract Patients Based on Lens Nucleus Hardness Grading

Qinhua Jiang, Ling Shen Department of Ophthalmology, Nanjing Aier Eye Hospital, Nanjing, Jiangsu Province, 210000, People’s Republic of ChinaCorrespondence: Ling Shen, Nanjing Aier Eye Hospital, No. 100, Xianhe Street, Qinhuai District, Nanjing, Jiangsu Province, People’s Republic of China, Email [email protected]: To investigate the risk factors associated with dry eye disease (DED) development in cataract (CAT) patients following phacoemulsification surgery, with a focus on lens nucleus hardness grading, and to develop a predictive model for individualized clinical management.Methods: This retrospective study included 150 cataract patients who underwent phacoemulsification from January 2023 to January 2025. Lens nucleus hardness was graded using the Emery system. Preoperative assessments included ocular surface status and systemic comorbidities. Logistic regression was used to identify independent risk factors, and a predictive model was developed and evaluated by receiver operating characteristic (ROC) analysis.Results: Postoperative DED occurred in 38.7% of patients. Multivariate analysis revealed that diabetes mellitus, history of keratoconjunctivitis, conjunctivochalasis grade ≥III, lens nucleus hardness grade ≥IV, and 3.0 mm clear limbal incision were independent risk factors (all P< 0.05). The prediction model showed good performance (AUC=0.836), with 84.5% sensitivity and 69.6% specificity.Conclusion: Lens nucleus hardness, along with key clinical factors, independently predicts DED risk after cataract surgery. The developed model may assist in early risk identification and personalized perioperative management.Keywords: cataract, dry eye disease, conjunctivochalasis severity, lens nucleus hardness, diabetes mellitus