Purpose

The identification of healthy persons more susceptible to dry eye (DED) symptoms developing after surgery remains an unmet need. We performed this study to build a new Ocular Surface Frailty Index (OSFI) and assess its predictive value for DED symptom onset after cataract surgery.

Design

Single-center, observational, longitudinal study.

Participants

We screened 405 consecutive patients scheduled for phacoemulsification for age-related cataract. Two hundred eighty-four eyes of 284 patients without preoperative DED symptoms who underwent uneventful cataract surgery were included in the analysis.

Methods

We built a tool to assess ocular surface frailty. Starting from a preliminary list of 19 potential items, the final OSFI, including 10 deficits in ocular surface health, factors potentially able to affect it, or both, was developed by a stepwise approach. Preoperative OSFI results were calculated for each enrolled patient and diagnostic tests for DED were performed at the screening visit and 1 week, 1 month, and 3 months after surgery. We evaluated the ability of OSFI to predict the presence of DED symptoms at 1 month or 3 months after surgery, or both.

Main Outcome Measures

The rate of ocular surface symptoms at 1 month or 3 months after surgery, or both.

Results

Our patients’ OSFI scores ranged from 0 to 0.666, with a median value of 0.200. The percentage of patients with postsurgical ocular surface symptoms was 17%. Using an OSFI cutoff of 0.300, we identified a small group (19% of the asymptomatic patients) with frail ocular surfaces who showed a significantly higher risk of postsurgical DED symptoms develop (50.0% vs. 9.6%; P < 0.001, chi-square test). Logistic regression analysis showed that OSFI results of 0.3 or more (but not age, gender, or any preoperative sign) was a good predictor of ocular surface symptom onset (odds ratio, 9.45; 95% confidence interval, 4.74–18.82). Regression remained significant when performed on 200 bootstrapped samples.

Conclusions

The OSFI can be calculated easily and quickly using noninvasive and low-tech procedures, and it proved to be predictive of postoperative DED symptoms onset. This novel tool may allow cataract surgeons to perform a useful preoperative personalized risk assessment.

中文翻译：

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眼表脆弱指数可预测白内障手术后眼表症状的发作。

目的

仍没有满足对在手术后出现干眼症（DED）症状的健康人的识别方面的需求。我们进行了这项研究，以建立新的眼表脆弱指数（OSFI），并评估其对白内障手术后DED症状发作的预测价值。

设计

单中心，观察性，纵向研究。

参加者

我们筛选了405例计划进行年龄相关性白内障超声乳化的连续患者。分析包括284例无术前白内障手术的无术前DED症状的284眼。

方法

我们建立了一种评估眼表脆弱性的工具。从19个潜在项目的初步清单开始，通过逐步方法开发出最终的OSFI，包括10个眼表健康缺陷，可能影响其的因素，或两者兼而有之。计算每个入组患者的术前OSFI结果，并在筛选访视时以及手术后1周，1个月和3个月进行DED的诊断测试。我们评估了OSFI预测术后1个月或3个月或两者兼有的DED症状的能力。

主要观察指标

术后1个月或3个月或两者兼有的眼表症状发生率。

结果

我们患者的OSFI评分范围从0到0.666，中位数为0.200。术后眼表症状患者的百分比为17％。使用0.300的OSFI临界值，我们确定了一小部分（无症状患者的19％）眼表虚弱，他们表现出较高的术后DED症状发生风险（50.0％对9.6％；P <0.001，卡方测试）。Logistic回归分析表明，OSFI结果为0.3或更高（而不是年龄，性别或任何术前体征）的患者，可以很好地预测眼表症状的发作（赔率，9.45； 95％置信区间，4.74–18.82）。当对200个自举样品进行回归分析时，回归仍然显着。

结论

OSFI可以使用无创且技术含量低的程序轻松快速地计算出，并被证明可预测术后DED症状的发作。这种新颖的工具可以使白内障外科医生能够进行有用的术前个性化风险评估。