PDF(Pubmed)
Abstract：
Patient expectations for cataract surgery are continuously increasing, and dry eye disease (DED) represents a major cause of patient dissatisfaction in eye surgery. The present opinion paper aims to provide useful insights to improve the entire pathway of a patient undergoing cataract surgery, from the preoperative setting to the postoperative one. The available evidence from main clinical trials published on this topic is presented in association with experience-based points of view by the authors. Ocular surface disease (OSD) is common in patients presenting for cataract surgery, and more than half of these patients have DED and meibomian gland dysfunction (MGD), even in the absence of symptoms. Therefore, there is a need to encourage preoperative assessments for the risk of DED development or worsening in all patients as a routine approach to cataract surgery. New all-in-one diagnostic machines allow for fast and noninvasive screening of the ocular surface status. Once a preoperative diagnosis of DED/OSD is reached, ocular surface optimization should be obtained before surgery. In the case of unresolved OSD, the decision to delay surgery should be considered. The surgical procedure can be optimized by avoiding large incisions, limiting microscope light intensity and exposure, and avoiding an aspirating speculum or preserved eye drops. Postoperatively, the continued avoidance of preserved agents is advisable, as well as a limited exposure to epitheliotoxic antibiotics and nonsteroidal anti-inflammatory drugs. Short-term, preservative-free, soft corticosteroids may be useful for patients with extensive or persistent inflammation.
摘要：
患者对白内障手术的期望不断提高，干眼症（DED）是眼科手术中患者不满的主要原因。本观点文件旨在提供有用的见解，以改善接受白内障手术的患者的整个途径，从术前设置到术后设置。作者根据基于经验的观点提出了有关该主题的主要临床试验的可用证据。眼表疾病（OSD）在接受白内障手术的患者中很常见，这些患者中有一半以上患有DED和睑板腺功能障碍（MGD），即使没有症状。因此,作为白内障手术的常规方法,有必要鼓励所有患者术前评估DED发展或恶化的风险.新的一体化诊断机器允许快速和非侵入性的眼表状态筛查。一旦达到DED/OSD的术前诊断，手术前应进行眼表优化。在未解决的OSD的情况下，应考虑推迟手术的决定.手术过程可以通过避免大切口来优化，限制显微镜的光强度和曝光，避免使用吸气镜或保留的眼药水。术后,建议继续避免被保存的代理人，以及对上皮毒性抗生素和非甾体类抗炎药的有限暴露。短期,不含防腐剂,软皮质类固醇对广泛或持续性炎症患者可能有用.
