Effect of posterior chamber phakic refractive lens implantation on the ocular surface and tear film

Abstract

To evaluate changes in dry eye-related parameters after posterior chamber phakic refractive lens (PC-PRL) implantation. This prospective study included 21 highly myopic patients (39 eyes) who underwent PC-PRL implantation at Lanzhou Huaxia Eye Hospital between January 2021 and June 2022, with a 3-month postoperative follow-up. In addition to routine preoperative examinations, dry eye assessments were conducted preoperatively and at 1 week, 1 month, and 3 months postoperatively. These assessments included the Ocular Surface Disease Index (OSDI) questionnaire score, non-invasive first tear break-up time (NIF-BUT), non-invasive average tear break-up time (NIA-BUT), tear meniscus height (TMH), meibomian gland loss (MGL) rate, and Schirmer I test (SIt). Repeated measures ANOVA was used to compare the differences in parameters across different time points, with pairwise comparisons conducted using the LSD- t test. After grouping, the Student's t-test was applied to compare normally distributed data, while the Mann–Whitney U test was used for non-normally distributed data. Categorical data were analyzed using the chi-square test. A total of 21 patients (39 eyes) were included, comprising 10 males (19 eyes) and 11 females (20 eyes), aged 19 to 49 years (33.76 ± 7.87). All patients completed the 3-month follow-up. Significant differences in OSDI scores were observed pre- and post-surgery ( P = 0.008), with a peak at one week post-surgery ( P < 0.001), then stabilizing at one and three months post-surgery. Postoperative NIF-BUT and NIA-BUT significantly decreased ( P < 0.001 for both) but returned to preoperative levels within three months. There were no significant changes in TMH, MGL, or SIt postoperatively ( P > 0.05). Significant differences in dry eye parameters were observed between the dry eye and control groups before and after surgery ( P < 0.001). PC-PRL implantation impacts tear film stability on the ocular surface after surgery, leading to varying degrees of dry eye symptoms in patients. After surgery, all dry eye parameters return to their preoperative levels within three months.