Impact of polyethylene glycol 400/propylene glycol/hydroxypropyl-guar and 0.1% sodium hyaluronate on postoperative discomfort following cataract extraction surgery: a comparative study

Georgios Labiris, Panagiota Ntonti, Haris Sideroudi, Vassilios Kozobolis, Georgios Labiris, Panagiota Ntonti, Haris Sideroudi, Vassilios Kozobolis

Abstract

Background: Universal postoperative guidelines for cataract extraction surgery are yet to be introduced. Artificial tears are gaining popularity as an additional integral component of the postoperative regime. The primary objective of this study was to explore the impact of two prevalent artificial tear preparations on postoperative discomfort following cataract extraction surgery.

Methods: A total of 180 patients that underwent cataract extraction surgery were randomly divided into three groups according to their postoperative regime: a) Study group 1 (SG1) received a fixed combination of tobramycin and dexamethasone (FCTD) quid for 3 weeks and, additionally polyethylene glycol 400/propylene glycol/hydroxypropyl-guar quid, for 6 weeks, b) Study group 2 (SG2) received FCTD quid for 3 weeks and, additionally 0.1% sodium hyaluronate provided in the COMOD® device quid, for 6 weeks, and, c) Control Group (CG) received only FCTD quid for 3 weeks. The following indexes were evaluated at three postoperative checkpoints: 1) Subjective discomfort index (SDI) derived from four direct 10-scale Likert-type questions that were addressed to the patient and pertained to: a) foreign body sensation (FBS), b) blinking discomfort (BD), c) stinging sensation (SS), d) tearing sensation (TS), 2) Tear break-up time (TBUT), 3) Central corneal thickness (CCT) and, 4) Central Corneal Sensitivity (CCS).

Results: Both groups showed increased CCT values at the first examination point and reduced CCS values at all examination points. Furthermore, both SGs had better TBUT times at all examination points compared to CG (CG: 8.86 ± 1.08, SG1: 9.59 ± 1.45, CG2: 9.45 ± 1.33, p < 0.05). BD was significantly better in both SGs only at the 1st week of examination, while SDI values were better until the 3rd week and only borderline better at 6th week. Lastly, no significant differences were detected between SGs, regarding all parameters, at all examination points.

Conclusion: Polyethylene glycol 400/propylene glycol/hydroxypropyl-guar and 0.1% sodium hyaluronate provided in the COMOD® device seem to be equally efficient in alleviating OSD symptoms following cataract extraction surgery and any of them should be routinely added to the postoperative regime.

Trial registration: ClinicalTrials.gov Identifier: https://ichgcp.net/clinical-trials-registry/NCT02558218NCT02558218.

Keywords: Artificial tears; Cataract; Hylocomod; Postoperative regimen; Surface discomfort index; Systane.

Figures

Fig. 1
Fig. 1
Tear break-up time chart
Fig. 2
Fig. 2
Foreign Body Sensation chart
Fig. 3
Fig. 3
Blinking discomfort chart
Fig. 4
Fig. 4
Stinging sensation chart
Fig. 5
Fig. 5
Tearing sensation chart
Fig. 6
Fig. 6
Subjective discomfort index chart

References

    1. Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol. 2012;96(5):614–8. doi: 10.1136/bjophthalmol-2011-300539.
    1. Labiris G, Toli A, Polychroni D, Gkika M, Angelonias D, Kozobolis VP. Liquefaction for cataract extraction. Int J Ophthalmol. 2016;9(2):306–11.
    1. Labiris G, Gatzioufas Z, Giarmoukakis A, Sideroudi H, Kozobolis VP. Liquefaction versus torsional IP: a comparative study on endothelial cells, corneal edema and corneal sensitivity. Ophthalmic Res. 2013;49(1):37–42. doi: 10.1159/000342974.
    1. Day AC, Gore DM, Bunce C, Evans JR. Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery. Cochrane Database Syst Rev. 2016;7:CD010735. doi: 10.1002/14651858.CD010735.pub2.
    1. Labiris G, Giarmoukakis A, Patsiamanidi M, Papadopoulos Z, Kozobolis VP. Mini-monovision versus multifocal intraocular lens implantation. J Cataract Refract Surg. 2015;41(1):53–7. doi: 10.1016/j.jcrs.2014.06.015.
    1. Sutu C, Fukuoka H, Afshari NA. Mechanisms and management of dry eye in cataract surgery patients. Curr Opin Ophthalmol. 2016;27(1):24–30. doi: 10.1097/ICU.0000000000000227.
    1. Kasetsuwan N, Satitpitakul V, Changul T, Jariyakosol S. Incidence and pattern of dry eye after cataract surgery. PLoS ONE. 2013;8(11):e78657. doi: 10.1371/journal.pone.0078657.
    1. Kim SJ, Schoenberger SD, Thorne JE, Ehlers JP, Yeh S, Bakri SJ. Topical Nonsteroidal Anti-inflammatory Drugs and Cataract Surgery: A Report by the American Academy of Ophthalmology. Ophthalmology. 2015;122(11):2159–68. doi: 10.1016/j.ophtha.2015.05.014.
    1. Behndig A, Cochener B, Güell JL, Kodjikian L, Mencucci R, Nuijts RM, et al. Endophthalmitis prophylaxis in cataract surgery: overview of current practice patterns in 9 European countries. J Cataract Refract Surg. 2013;39(9):1421–31. doi: 10.1016/j.jcrs.2013.06.014.
    1. Sitompul R, Sancoyo GS, Hutauruk JA, Gondhowiardjo TD. Sensitivity change in cornea and tear layer due to incision difference on cataract surgery with either manual small-incision cataract surgery or phacoemulsification. Cornea. 2008;27(Suppl 1):S13–8. doi: 10.1097/ICO.0b013e31817f29d8.
    1. Jiang D, Xiao X, Fu T, Mashaghi A, Liu Q, Hong J. Transient Tear Film Dysfunction after Cataract Surgery in Diabetic Patients. PLoS ONE. 2016;11(1):e0146752. doi: 10.1371/journal.pone.0146752.
    1. Labiris G, Sideroudi H, Rousopoulos K, Kozobolis VP. Cohesive versus dispersive-cohesive ophthalmic viscosurgical device in torsional intelligent phaco. J Cataract Refract Surg. 2015;41(3):681–2. doi: 10.1016/j.jcrs.2015.01.010.
    1. Behrens A, Doyle JJ, Stern L, Chuck RS, McDonnell PJ, Azar DT, et al. Dysfunctional tear syndrome: a Delphi approach to treatment recommendations. Cornea. 2006;25(8):900–7. doi: 10.1097/01.ico.0000214802.40313.fa.
    1. Milner MS, Beckman KA, Luchs JI, Allen QB, Awdeh RM, Berdahl J, et al. Dysfunctional tear syndrome: dry eye disease and associated tear film disorders - new strategies for diagnosis and treatment. Curr Opin Ophthalmol. 2017;27(Suppl 1):3–47. doi: 10.1097/01.icu.0000512373.81749.b7.
    1. Liu Y, Zeng M, Liu X, Luo L, Yuan Z, Xia Y, et al. Torsional mode versus conventional ultrasound mode phacoemulsification. Randomized comparative clinical study. J Cataract Refract Surg. 2007;33:287–92. doi: 10.1016/j.jcrs.2006.10.044.
    1. Williams A, Sloan FA, Lee PP. Longitudinal rates of cataract surgery. Arch Ophthalmol. 2006;124:1308–14. doi: 10.1001/archopht.124.9.1308.
    1. Hood CT, Sugar A. Subjective complaints after cataract surgery: common causes and management strategies. Curr Opin Ophthalmol. 2015;26(1):45–9. doi: 10.1097/ICU.0000000000000112.
    1. Brown GC, Brown MM, Menezes A, Busbee BG, Lieske HB, Lieske PA. Cataract surgery cost utility revisited in 2012: a new economic paradigm. Ophthalmology. 2013;120:2367–76. doi: 10.1016/j.ophtha.2013.04.030.
    1. Li XM, Hu L, Hu J, Wang W. Investigation of dry eye disease and analysis of the pathogenic factors in patients after cataract surgery. Cornea. 2007;26(9 suppl 1):S16–20. doi: 10.1097/ICO.0b013e31812f67ca.
    1. Silverstein SM, Cable MG, Sadri E, Peace JH, Fong R, Chandler SP, et al. Once daily dosing of bromfenac ophthalmic solution 0.09% for postoperative ocular inflammation and pain. Curr Med Res Opin. 2011;27(9):1693–703. doi: 10.1185/03007995.2011.597663.
    1. Maxwell WA, Reiser HJ, Stewart RH, Cavanagh HD, Walters TR, Sager DP, et al. Nepafenac dosing frequency for ocular pain and inflammation associated with cataract surgery. J Ocul Pharmacol Ther. 2008;24(6):593–9. doi: 10.1089/jop.2008.0023.
    1. Camesasca FI, Bianchi C, Beltrame G, Caporossi A, Piovella M, Rapisarda A, et al. Control of inflammation and prophylaxis of endophthalmitis after cataract surgery: A multicenter study. Eur J Ophthalmol. 2007;17(1):733–42.
    1. Fong R, Leitritz M, Siou-Mermet R, Erb T. Loteprednol etabonate gel 0.5% for postoperative pain and inflammation after cataract surgery: results of a multicenter trial. Clin Ophthalmol. 2012;6:1113–24. doi: 10.2147/OPTH.S32643.
    1. Zhang Y, Cao H, Lin T, Gong L. Effects of artificial tears on rabbit ocular surface healing after exposure to benzalkonium chloride. Drug Chem Toxicol. 2016;39(4):455–60. doi: 10.3109/01480545.2016.1146293.
    1. Benelli U. Systane lubricant eye drops in the management of ocular dryness. Clin Ophthalmol. 2011;5:783–90. doi: 10.2147/OPTH.S13773.
    1. Schrage N, Frentz M, Spoeler F. The Ex Vivo Eye Irritation Test (EVEIT) in evaluation of artificial tears: Purite-preserved versus unpreserved eye drops. Graefes Arch Clin Exp Ophthalmol. 2012;250(9):1333–40. doi: 10.1007/s00417-012-1999-3.
    1. Christensen MT, Cohen S, Rinehart J, Akers F, Pemberton B, Bloomenstein M, et al. Clinical evaluation of an HP-guar gellable lubricant eye drop for the relief of dryness of the eye. Curr Eye Res. 2004;28(1):55–62. doi: 10.1076/ceyr.28.1.55.23495.
    1. Guillon M, Maissa C, Ho S. Evaluation of the effects on conjunctival tissues of Optive eyedrops over one month usage. Cont Lens Anterior Eye. 2010;33(2):93–9. doi: 10.1016/j.clae.2010.01.007.
    1. Mencucci R, Boccalini C, Caputo R, Favuzza E. Effect of a hyaluronic acid and carboxymethylcellulose ophthalmic solution on ocular comfort and tear-film instability after cataract surgery. J Cataract Refract Surg. 2015;41(8):1699–704. doi: 10.1016/j.jcrs.2014.12.056.
    1. Hardten DR. Dry eye disease in patients after cataract surgery. Cornea. 2008;27(7):855. doi: 10.1097/ICO.0b013e31816f6854.
    1. Sánchez MA, Arriola-Villalobos P, Torralbo-Jiménez P, Girón N, de la Heras B, Herrero Vanrell R, et al. The effect of preservative-free HP-Guar on dry eye after phacoemulsification: a flow cytometric study. Eye (Lond) 2010;24(8):1331–7. doi: 10.1038/eye.2010.24.

Source: PubMed

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