Purpose: This study aimed to investigate the role of tear substitutes on ocular comfort and tear film parameters after phacoemulsification in age-related cataracts.
Patients and methods: A prospective, randomized, controlled, single-center interventional study was conducted. Forty-one candidates (28 men, 13 women) for unilateral cataract surgery at the Ibn-Alhaitham Eye Teaching Hospital between October 2020 and February 2021 with a mean age of 59.80 + 6.15 years were randomly assigned to one of three groups: group A, B, and C. Group A received a standard postoperative cataract regimen of steroid–antibiotics combination and high-viscosity tear substitutes q.i.d.; group B received low-viscosity tear substitutes q.i.d; and group C, the control group, only received standard therapy. For all patients, the tear film break-up time (TBUT), Schirmer’s test without anesthesia, and ocular pain assessed by visual analog scale (VAS) were estimated at three points in time: before, at 1 week, and 1 month after surgery.
Results: The mean TBUT and Schirmer’s wetting, both at 1 week (P=0.001 and 0.004, respectively) and 1 month (P<0.001 for both tests) after surgery in group A was statistically significantly higher than groups B and C, while groups B and C did not show any significant difference. The VAS score was significantly lower in group A than in group B, which also demonstrated significantly lower VAS scores than group C both at 1 week (P<0.001) and 1 month (P<0.001), postoperatively. Intragroup comparisons revealed that the mean TBUT and Schirmer’s wetting improved over the preoperative baseline at 1 month in group A (P=0.001), returned to baseline in group B (P=0.33), and deteriorated in group C (P<0.001). Groups A and B had a reduction in VAS score from 1 week to 1 month after surgery (P=0.001 and 0.04, respectively); however, this was not observed in group C (P=0.56).
Conclusion: Tear substitutes are well tolerated and effective in reducing ocular discomfort after age-related cataract surgery with high-viscosity substitutes offering greater improvement. Further, tear film parameters were improved with the addition of high-viscosity substitutes to the standard post-cataract regimen.