Comparison of clinical and inflammatory markers for dry eye disease following phacoemulsification and manual small incision cataract surgery (MSICS)

We compared clinical and inflammatory markers in patients undergoing cataract surgery by phacoemulsification and manual small incision cataract surgery (MSICS) in 86 patients (43: MSICS, 43: phacoemulsification), 40 years or older, with uncomplicated cataracts. Dry eye evaluation was done preoperatively and on days 1, 21, and 60 after surgery by Ocular Surface Disease Index (OSDI) questionnaire, Schirmer's I test, tear film break-up time (TBUT), and National Eye Institute (NEI) ocular staining score; meibomian gland dysfunction (MGD) assessed using the Lid Margin Score (LMS) and Meibum quality score (MQS); tear fluid interleukins (IL), IL -1β and IL-6. The OSDI, Schirmer I, TBUT, and NEI OSS were significantly worse on post-op Day 1 and improved by Day 60; TBUT was significantly lower in the MSICS than in the phacoemulsification group at all post-op visits. Both groups had mild MGD that improved post-operatively, but MQS was significantly worse in the phacoemulsification group. IL-1β and IL-6 levels were higher on post-op Day 1, returning to near baseline levels by Day 60. We found that MSICS and phacoemulsification have acute detrimental effects on the ocular surface, as evidenced by clinical and inflammatory markers, with TBUT being considerably worse in the MSICS group and MGD being worse in the phacoemulsification group.