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Surgical Factors Affecting Changes in Ocular Surface Dynamics in the Early Postoperative Period After 25-Gauge Vitrectomy

Sato, Tatsuhiko M.D., Ph.D.; Koh, Shizuka M.D., Ph.D.; Yasukura, Yu-ichi M.D.; Kanai, Masanori M.D.; Noguchi, Yumi M.D.; Jhanji, Vishal M.D.; Nishida, Kohji M.D., Ph.D.

doi: 10.1097/ICL.0000000000000562

Objectives: Because vitrectomy-associated postoperative ocular surface changes are not well known, we evaluated such changes before and after vitrectomy in eyes with posterior segment diseases and investigated their associations with patients' characteristics and surgical procedures.

Methods: Thirty-five eyes of 32 consecutive patients (16 women; average age 66.6±11.1 years) were included in this prospective, noncomparative case series from tertiary care university hospital. Contact lens wearers and patients with history of ocular surgery or regular use of topical eyedrops were excluded. Patients had undergone primary 25-gauge vitrectomy at Osaka University Hospital in Japan between July and December 2016. Tear break-up time (TBUT), corneal and conjunctival fluorescein staining score (FSS), and tear meniscus height (TMH) were evaluated before, 1 week after, and 1 month after vitrectomy.

Results: Conjunctival FSS and TMH were significantly higher at 1 week after vitrectomy than preoperatively. However, they decreased significantly 1 month after. Changes in TBUT and corneal FSS showed a similar course at 1 week, but this was not statistically significant. Multiple linear regression analysis showed no significant correlation between significantly increased ocular parameters and patients' characteristics. By contrast, surgical time and combined cataract surgery significantly contributed to increased and decreased conjunctival FSS, respectively (P=0.011 and 0.033, respectively). Sclerotomy site suturing significantly contributed to increased TMH (P=0.025).

Conclusions: We showed associations between ocular surface changes and specific surgical procedures. Caution should be exercised to minimize the effect of surgical procedures on the ocular surface during vitrectomy.

Hayashi Eye Hospital (T.S.), Fukuoka, Japan; Departments of Innovative Visual Science (S.K.), and Ophthalmology (T.S., S.K., Y.Y., M.K., Y.N., and K.N.), Osaka University Graduate School of Medicine, Suita, Japan; Department of Ophthalmology (V.J.), University of Pittsburgh School of Medicine, Pittsburgh, PA; and Department of Ophthalmology and Visual Sciences (V.J.), The Chinese University of Hong Kong, Hong Kong.

Address correspondence to Shizuka Koh, M.D., Ph.D., Department of Innovative Visual Science, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan; e-mail:

The authors have no funding or conflicts of interest to disclose.

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Accepted September 30, 2018

© 2019 Contact Lens Association of Ophthalmologists, Inc.