Evaluation of dry eye after femtosecond laser-assisted cataract surgery

Purpose: To compare dry-eye signs and symptoms after femtosecond laser-assisted cataract surgery and conventional phacoemulsification.

Setting: Eye Center of the 2nd Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China.

Design: Prospective consecutive nonrandomized comparative cohort study.

Methods: Consecutive patients who had femtosecond laser-assisted or phacoemulsification cataract surgery were assessed. Dry-eye markers including the ocular surface disease index (OSDI) and subjective symptom questionnaire, tear-film assessment using Keratograph 4 corneal topography, Schirmer testing I, and fluorescein staining were sequentially evaluated preoperatively and postoperatively at 1 day, 1 week, and 1 month.

Results: The study recruited 137 eyes (137 patients) with similar baseline characteristics. Most patients developed dry eye postoperatively. Subjective symptoms and fluorescein staining scores elevated from baseline, tear breakup time and Schirmer testing I values decreased postoperatively, which peaked at 1 week and did not return to baseline within 1 month. There were no significant differences between the 2 groups (all P > .05) except for a higher fluorescein staining score in the femtosecond group at 1 day (P = .001), 1 week (P = .047), and 1 month (P = .025). OSDI score and subjective symptoms were greater in the laser group at 1 week (P = .014 and P = .016, respectively). Subgroup analysis showed obvious worsening by fluorescein staining at 1 day (P = .016) and 1 month (P = .009) in preoperative dry-eye patients.

Conclusions: Both methods worsened dry eye postoperatively. Femtosecond-assisted surgery had a higher risk for staining and dry-eye symptoms. Patients with preexisting dry eye who had femtosecond-assisted surgery had more severe ocular surface staining than those having conventional surgery.

Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.