title: Transient Tear Film Dysfunction after Cataract Surgery in Diabetic Patients.
abstract: OBJECTIVE
  Diabetes mellitus is an increasingly common systemic disease. Many diabetic patients seek cataract surgery for a better visual acuity. Unlike in the general population, the influence of cataract surgery on tear film function in diabetic patients remains elusive. The aim of this study was to evaluate the tear function in diabetic and nondiabetic patients following cataract surgery.
  
  
  METHODS
  In this prospective, interventional case series, 174 diabetic patients without dry eye syndrome (DES) and 474 age-matched nondiabetic patients as control who underwent phacoemulsification were enrolled at two different eye centers between January 2011 and January 2013. Patients were followed up at baseline and at 7 days, 1 month, and 3 months postoperatively. Ocular symptom scores (Ocular Surface Disease Index, OSDI) and tear film function including tear film stability (tear film break-up time, TBUT), corneal epithelium integrity (corneal fluorescein staining, CFS), and tear secretion (Schirmer's I test, SIT) were evaluated.
  
  
  RESULTS
  In total, 83.9% of the diabetic patients (146 cases with 185 eyes) and 89.0% of the nondiabetic patients (422 cases with 463 eyes) completed all check-ups after the interventions (P = 0.095). The incidence of DES was 17.1% in the diabetic patients and 8.1% in the nondiabetic patients at 7 days after cataract surgery. In the diabetic patients, the incidence of DES remained 4.8% at 1 month postoperatively and decreased to zero at 3 months after surgery. No DES was diagnosed in nondiabetic patients at either the 1-month or 3-month follow-up. Compared with the baseline, the diabetic patients had worse symptom scores and lower TBUT values at 7 days and 1 month but not at 3 months postoperatively. In the nondiabetic patients, symptom scores and TBUT values had returned to preoperative levels at 1-month check-up. CFS scores and SIT values did not change significantly postoperatively in either group (P = 0.916 and P = 0.964, respectively).
  
  
  CONCLUSIONS
  Diabetic patients undergoing cataract surgery are prone to DES. Ocular symptoms and tear film stability are transiently worsened in diabetic patients and are restored more slowly than those in nondiabetic patients.
authors.affiliation: Department of Ophthalmology, The Second People Hospital, Taixing, China.
authors.forename: Donghong
authors.initials: D
authors.lastname: Jiang
authors.affiliation: Department of Ophthalmology, The Second People Hospital, Taixing, China.
authors.forename: Xiangqian
authors.initials: X
authors.lastname: Xiao
authors.affiliation: Department of Ophthalmology, People Hospital, Yangzhong, China.
authors.forename: Tongsheng
authors.initials: T
authors.lastname: Fu
authors.affiliation: Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Alireza
authors.initials: A
authors.lastname: Mashaghi
authors.affiliation: Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Qinghuai
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Department of Ophthalmology and Visual Science, Eye, and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.|Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States of America.|Key Laboratory of Myopia of State Health Ministry and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shangha.|School of Life Sciences, Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Fujian, China.
authors.forename: Jiaxu
authors.initials: J
authors.lastname: Hong
mesh_terms: D000368:Aged; D002387:Cataract Extraction / Q000009:adverse effects*; D003920:Diabetes Mellitus / Q000601:surgery*; D015352:Dry Eye Syndromes / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D011446:Prospective Studies