Comparison of tear film dysfunction after phacoemulsification between diabetics and non-diabetics

Objectives: To compare early postoperative tear film break-up time (TBUT) after phacoemulsification between diabetic and non-diabetic cataract patients. Study design: Quasi-experimental (comparative) study. Place and duration of study: Ophthalmology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan; July 2024 – September 2024. Patients and methods: Sixty-six patients scheduled for phacoemulsification with intraocular lens implantation were enrolled by consecutive non-probability sampling: 33 long-standing diabetics (> 5 years) and 33 non-diabetics. Exclusion criteria included prior ocular surface disease, significant meibomian gland dysfunction, prior ocular surgery, topical ocular medication use, or complicated surgery. All surgeries used a 2.8 mm temporal clear corneal incision under topical anesthesia. TBUT was measured at slit lamp using fluorescein one day preoperatively and one day postoperatively. TBUT <10 s was considered abnormal. Statistical analysis employed paired-samples t-tests for within-group comparisons and independent-samples t-tests for between-group comparisons (SPSS v23); p<0.05 was considered significant. Results: Mean preoperative TBUT did not differ between groups (diabetics 12.70±3.72 seconds; non-diabetics 12.79±3.65 seconds; p=0.92). Postoperatively, TBUT decreased in both groups, with a significantly greater reduction in diabetics (7.36±2.16 seconds) than non-diabetics (10.42±3.56 seconds) (p<0.01). Conclusion: Diabetic patients experienced a significantly larger early postoperative decline in TBUT following phacoemulsification compared with non-diabetics. Consideration should be given to prophylactic or early postoperative lubricants for diabetic patients to mitigate dry-eye symptoms.