Department of Clinical Sciences and Community Health, University of Milan, Eye Clinic San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Eye Clinic San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy.
Ophthalmology. 2020 Jul;127(7):866-873. doi: 10.1016/j.ophtha.2019.12.012. Epub 2019 Dec 28.
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.
Single-center, observational, longitudinal study.
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.
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.
The rate of ocular surface symptoms at 1 month or 3 months after surgery, or both.
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.
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.
识别更易出现术后干眼（DED）症状的健康人群仍然是一项未满足的需求。我们进行了这项研究，以建立一个新的眼表脆弱指数（OSFI），并评估其对白内障手术后 DED 症状发作的预测价值。
单中心、观察性、纵向研究。
我们筛选了 405 例计划行超声乳化白内障吸除术的连续患者。纳入分析的是 284 例无术前 DED 症状且无手术并发症的患者的 284 只眼。
我们建立了一种评估眼表脆弱性的工具。从一个初步的 19 个潜在项目清单开始，通过逐步方法开发了一个包括 10 个眼表健康缺陷、可能影响其的因素或两者兼有的最终 OSFI。为每位入组患者计算术前 OSFI 结果，并在筛选就诊时以及术后 1 周、1 个月和 3 个月进行 DED 诊断测试。我们评估了 OSFI 预测术后 1 个月或 3 个月或两者均出现 DED 症状的能力。
术后 1 个月或 3 个月或两者均出现眼表症状的发生率。
我们患者的 OSFI 评分范围为 0 至 0.666，中位数为 0.200。术后出现眼表症状的患者比例为 17%。使用 OSFI 截断值 0.300，我们发现一小部分（无症状患者的 19%）眼表脆弱的患者出现术后 DED 症状的风险显著更高（50.0% vs. 9.6%；P < 0.001，卡方检验）。Logistic 回归分析显示，OSFI 结果为 0.3 或更高（但不包括年龄、性别或任何术前体征）是眼表症状发作的良好预测因素（优势比，9.45；95%置信区间，4.74-18.82）。在对 200 个 bootstrap 样本进行回归分析时，结果仍然显著。
OSFI 可以使用非侵入性和低技术程序轻松快速地计算，并且已被证明可以预测术后 DED 症状的发作。这种新工具可能使白内障外科医生能够进行有用的术前个体化风险评估。
