Evaluation of dry eye pre and post phacoemulsification in diabetic patients.

Introduction: Dry eye is a common condition influenced by various factors, including cataract surgery and systemic diseases like diabetes. Phacoemulsification, a widely used cataract procedure, often leads to increased postoperative dry eye symptoms due to inflammation and changes in tear film stability. Diabetic patients, already prone to dry eye, may experience further worsening after surgery. This study evaluates dry eye status in diabetic patients before and after phacoemulsification.

Materials and methods: This study included 126 patients, divided into diabetic and non-diabetic groups from Hospital Melaka and Hospital Pakar Universiti Sains Malaysia between September 2022 and July 2024. Patient demographics and dry eye parameters, including the Ocular Surface Disease Index (OSDI), Tear Break-Up Time (TBUT), and Schirmer's test, were evaluated at baseline, one week, and three months after surgery. Only patients who underwent uncomplicated phacoemulsification were included, while those undergoing extracapsular cataract extraction, intracapsular cataract extraction, or lens aspiration were excluded. The mean values of OSDI, TBUT, and Schirmer's test across the three time points were compared among groups with diabetic retinopathy, without diabetic retinopathy and non-diabetic patients using repeated measures ANOVA.

Results: 126 patients were studied: 44 non-diabetic, 40 diabetic without retinopathy (no DR), and 42 diabetics with retinopathy (DR). The mean ± SD (standard deviation) age was 64.06 ± 5.30 years, with males comprising 54.0% of the cohort. Hypertension was the highest proportion of comorbidity (75.4%), particularly in the DR group (90.5%). Dry eye parameters showed significant temporary changes post-cataract surgery. OSDI scores improved significantly from baseline to three months in all groups, with diabetic groups showing higher scores at three months than nondiabetics (p < 0.05). TBUT declined significantly at one week in the diabetic groups (DR, p = 0.028; no DR, p = 0.019) but showed substantial recovery by three months, with significant improvements across all groups. In all groups, Schirmer's test values improved significantly between one week and three months (p < 0.05), although baseline and one-week differences were not statistically significant.

Conclusion: Three months after cataract surgery, significant improvements in OSDI scores, TBUT, and Schirmer's test values were observed, indicating a recovery in dry eye status. Diabetic patients experienced more pronounced early postoperative changes but demonstrated comparable recovery trends to non-diabetics by three months. These findings highlight the importance of monitoring dry eye parameters in diabetics, particularly during the early postoperative period, to optimise outcomes and patient satisfaction.