Maintaining a healthy ocular surface after surgery · DRY eye symptoms can be unwelcome sequelae...
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DRY eye symptoms can be unwelcome sequelae following many types of eye surgery including cataract, refractive and corneal transplantation.With increasing clinical experience, surgeons are learning ways to minimise the risks for post- operative dry eye, and for treating it when it does occur, reported researchers at a EuroTimes Satellite Education Programme held during the XXIII Congress of the ESCRS. “Dry eye is a complex multifactorial disease and maintaining a healthy ocular surface post-operatively is a growing challenge.There are many steps ocular surgeons can take to identify at risk patients pre-operatively, and to minimise post-operative complications involving the ocular surface,” said Jorge Palmares MD, Hospital de S. João, Porto, Portugal. These steps include identifying high-risk patients in advance, such as those with diabetes, advanced age, and those with contact lens intolerance.These patients should be advised about the increased risk of post- operative dry eye problems. “Dry eye symptoms are more common among our patients than we previously realised.This is important because dry eye causes problems with many types of eye surgery,” he said. Dry eye post-LASIK Luigi Oliveri MD, San Benedetto del Tronto, Italy, discussed the use of ocular surface lubricants after LASIK, noting that dry eye complaints can occur in half of refractive laser surgery patients. He conducted a clinical trial in 30 LASIK patients who used Systane drops (hydroxypropyl- guar, peg-400 and polietilene glycol,Alcon) postoperatively. He reported that after three months the drops had reduced dry eye symptoms and improved tear break-up time. He explained that when components in Systane combine with natural tears, a chemical reaction occurs, forming a gel- like matrix.This creates an ocular shield, allowing epithelial repair in a healthy ocular surface environment. “Systane is a good idea in these patients. It acts like a protective shield.The patients had improved quality of vision, along with improved quality of life.” Maintaining a healthy ocular surface after surgery EuroTimes December 2005 James McCulley Jorge Palmares Juan Duran De la Colina Reducing sub-basal and stromal innervation decreases corneal sensitivity, which in turn disrupts the pathways that drive proper production of tear components resulting in poor or insufficient tear quality and unhealthy ocular surface. Several studies have demonstrated that the signs and symptoms of dry eye worsen post-LASIK. Systane preferentially binds to damaged areas on the ocular surface endothelium. By preferentially adhering to the endothelium, Systane provides the foundation for the protective shield. Courtesy of Luigi Olivieri MD “Dry eye is a complex multifactorial disease and maintaining a healthy ocular surface post- operatively is a growing challenge. Jorge Palmares MD
Transcript of Maintaining a healthy ocular surface after surgery · DRY eye symptoms can be unwelcome sequelae...
DRY eye symptoms can beunwelcome sequelae followingmany types of eye surgeryincluding cataract, refractive andcorneal transplantation.Withincreasing clinical experience,surgeons are learning ways tominimise the risks for post-operative dry eye, and fortreating it when it does occur,reported researchers at aEuroTimes Satellite EducationProgramme held during theXXIII Congress of the ESCRS.
“Dry eye is a complexmultifactorial disease andmaintaining a healthy ocularsurface post-operatively is agrowing challenge.There aremany steps ocular surgeons cantake to identify at risk patientspre-operatively, and to minimisepost-operative complicationsinvolving the ocular surface,” saidJorge Palmares MD, Hospital deS. João, Porto, Portugal.
These steps include identifyinghigh-risk patients in advance,such as those with diabetes,advanced age, and those withcontact lens intolerance.Thesepatients should be advised aboutthe increased risk of post-operative dry eye problems.
“Dry eye symptoms are morecommon among our patientsthan we previously realised.This
is important because dry eyecauses problems with manytypes of eye surgery,” he said.
Dry eye post-LASIKLuigi Oliveri MD, San Benedettodel Tronto, Italy, discussed theuse of ocular surface lubricantsafter LASIK, noting that dry eyecomplaints can occur in half ofrefractive laser surgery patients.
He conducted a clinical trial in30 LASIK patients who usedSystane drops (hydroxypropyl-guar, peg-400 and polietileneglycol,Alcon) postoperatively. Hereported that after three monthsthe drops had reduced dry eyesymptoms and improved tearbreak-up time.
He explained that whencomponents in Systane combine
with natural tears, a chemicalreaction occurs, forming a gel-like matrix.This creates anocular shield, allowing epithelialrepair in a healthy ocular surfaceenvironment.
“Systane is a good idea inthese patients. It acts like aprotective shield.The patientshad improved quality of vision,along with improved quality oflife.”
Maintaining a healthy ocular surface after surgery
EuroTimes December 2005
James McCulley Jorge Palmares Juan Duran De la Colina
Reducing sub-basal and stromal innervation decreases corneal sensitivity, which in turn disrupts the pathwaysthat drive proper production of tear components resulting in poor or insufficient tear quality and unhealthy
ocular surface.
Several studies have demonstrated that the signs and symptoms of dry eye worsen post-LASIK.
Systane preferentially binds to damaged areas on the ocular surface endothelium. By preferentially adhering tothe endothelium, Systane provides the foundation for the protective shield.
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“Dry eye is acomplexmultifactorialdisease andmaintaining ahealthy ocularsurface post-operatively is agrowing challenge.
Jorge Palmares MD
Dry eye also a problem aftercataract surgeryWhile dry eye complaints arenot uncommon after LASIKsurgery, cataract patients alsoappear to have dry eye problemsafter cataract surgery, said JuanDuran De la Colina MD, fromUniversity of Basque Country,Bilbao, Spain
“Many of us used to thinkcommon dry eye complaintswere psychosomatic in mostcases, but we now havesupportive scientific evidencethat something is indeedhappening on the ocular surfaceof LASIK eyes of many patients.I’m sure we are inducing changesin eyes of cataract patients aswell.We are seeing manypatients after cataract surgerywho tell us they are seeing wellbut are having real problemswith dry eye symptoms.”
He noted that cataractpatients are often alreadypredisposed to dry eyeproblems, because of factorsincluding age, and the adverseeffects of various medications.Moreover, several aspects of thecataract surgery itself canengender dry eye problems.Thisincludes the pre-operativedilation, the use of antiseptics,and preserved anaesthetic drops.
During the surgery, the use ofthe speculum, and the creationof the incision, can also beproblematic. Finally, in thepostoperative stage patients maybe using eye drops withpreservatives that may actuallymake the situation worse.
He advised several steps toreduce dry eye complaint incataract patients. Patients,especially those withpredisposing factors such as lidlaxity should be informed inadvance of potential dry eyeproblems. Conscientious surgerycan also help reduce post-operative dry eye.This includesminimising the stretching of lids,and limiting the use of dropsthat include toxic preservatives.
Systane useful both pre- andpost-opHe emphasised the importanceof using unpreserved artificialtears post-operatively. He notedthat he had found new artificialtears like Systane drops to be avery useful approach in manycases. Patients with severeclinical dry eye might benefitfrom pre-operative prophylaxiswith such drops.
US surgeon James McCulleyMD concurred: "I've been usingSystane since it came out.Systane is now the first linetherapy for all of my dry eyepatients. I use it pre- and post-op for LASIK patients. It worksalone quite well in cases of mildto moderate dry eye.The q.i.ddosing is actually therapeutic, incontrast to what we were doingbefore, putting in an artificialtear replacement that was justsalt and water. I've beendelighted with the results."
Researchers compared theeffects of Systane and salinedrops in a multi-centre,randomised, placebo-controlledtrial. Eighty-seven dry eyepatients applied the drops inboth eyes four times per day.Allpatients had a sodiumfluorescein corneal stainingscore of greater than three intheir worse eye at the time ofenrolment.
Patients receiving Systane alsoreported more symptomaticimprovement than the controlgroup. Questionnaires revealedless morning dryness, lessdryness at the end of the dayand less frequent foreign bodysensation.
Jorge Palmares [email protected]
Luigi Oliveri [email protected]
Juan Duran De la Colina [email protected]
James McCulley [email protected]
EuroTimes December 2005
Tear film break-up time useful on diagnosis of dry eye as indicated by dark areas on the cornea (< 15 seconds)
Allergic conjunctivitis has impact on surgical outcomes due to increased incidence of toxicity reactions tomedications and preservatives.
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We are seeingmany patientsafter cataractsurgery who tellus they are seeingwell but arehaving realproblems with dryeye symptoms.”
Juan Duran De la Colina MD
“Systane is nowthe first linetherapy for all ofmy dry eyepatients. I use itpre- and post-opfor LASIKpatients.”
James McCulley MD
BA+B: Dry eye and corneal erosion in a diabetic patient
Cicatricial conjunctivitis with dry eye.
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