In FLACS, secondary suction may worsen early dry eye. Smaller corneal diameter and significant eye movement are risk factors.
Abstract
Purpose:
To explore secondary suction’s impact on postoperative ocular surface, tear factors, and dry eye risk factors in femtosecond laser–assisted cataract surgery (FLACS).
Setting:
Xiamen Eye Center, Xiamen University, Xiamen, China.
Design:
Prospective cohort study; patients grouped by intraoperative secondary suction (no randomization/masking).
Methods:
Age-related patients with cataract undergoing FLACS (December 2023 to May 2024) were included (inclusion: FLACS consent, no prior eye surgery/trauma, and pupil dilation >7 mm; exclusion: ≥3 suction attempts, lens dislocation, pregnancy, psychiatric issues, and poor compliance). Preoperative parameters (corneal diameter and corneal keratometry value) and intraoperative eye movement were recorded. Ocular surface disease index (OSDI), tear meniscus height (TMH), and tear cytokines were assessed preoperatively and at 1 day, 1 week, and 1 month postsurgery.
Results:
41 patients (21 secondary suction, 20 conventional) were analyzed. The secondary suction group had higher 1-week OSDI (6.43 ± 7.96 vs 1.90 ± 5.85; P = .045), higher 1-week (0.04 ± 0.09 vs 0.01 ± 0.07 mm; P = .020) and 1-month TMH (0.07 ± 0.17 vs 0.03 ± 0.07 mm; P = .023), and greater tear interleukin-6 log increases at 1 day (0.44 ± 0.68 vs −0.04 ± 0.78; P = .042) and 1 week (0.01 ± 0.64 vs −0.49 ± 0.89; P = .045). Risk factors: smaller corneal diameter (P = .025) and obvious eye movement (P < .001).
Conclusions:
Secondary suction in FLACS may worsen early-stage postoperative dry eye, but it recovers in 1 month. Key risk factors for secondary suction include smaller corneal diameter and significant ocular movement, which inform targeted prevention strategies to reduce secondary suction incidence.
