Changes In Corneal Surface Aberrations And Nerve Density After Cataract Surgery Of Patients With Dry Eye Disease

Purpose: To evaluate the change patterns in corneal aberrations and nerve density after cataract surgery in dry eye disease (DED).Methods: One hundred and six eyes of 69 patients with dry eye were included in this study. The preoperative, 1-month and 3-month postoperative dry eye-related indices were obtained by the Oculus keratograph and the ocular surface disease index (OSDI) questionnaire. The corneal aberrations and corneal surface regularity indices were measured using a Pentacam HR system. In vivo confocal microscopy (ICVM) was performed to observe sub-basal corneal nerves of vortex and superior periphery, and corneal endothelial number. An artificial intelligence (AI) technique run by the deep learning model generated the sub-basal nerve fibre parameters.Results: One hundred and six eyes of 69 patients with DED (mean age, 69.32±8.91 years) were recruited. Corneal aberrations on the anterior and total corneal surfaces increased significantly at 1 month after surgery compared with the baseline values but gradually returned to the baseline by 3 months after surgery. Significant changes in posterior corneal HOAs occurred at 1-month and 3-month. Corneal endothelial cells decreased continuously until 3 months after operation. There were significantly lessen in corneal vortical nerve maximum length and average density after operation, these damages were present after 3 months. But for corneal peripheral nerve, these damages lasted only 1 month after operation. The corneal vortical nerve maximum length and average density were negatively correlated with anterior corneal surface aberrations before and one month after surgery. Conclusions: After cataract surgery, changes in corneal aberrations occurred mainly both on the anterior and posterior surface. However, the change of posterior lasts longer. The corneal vortical nerve maximum length and average density are reduced after cataract surgery in patients with DED. Although the anterior corneal aberration will recover one month after cataract surgery, the dry eye state continues to worsen. IVCM is a useful tool to evaluate corneal sub-basal nerve changes in dry eye patients before and after cataract operation.