有肿瘤病史的年龄相关性白内障患者术后干眼的流行病学特征及可干预危险因素分析OA

Objective:To investigate the epidemiological characteristics and modifiable risk factors for surgery-related dry eye following cataract extraction in age-related cataract patients with a history of malignancy or those undergoing active antitu-mor therapy,and to provide a reference for the prevention and management of postoperative dry eye in this specific popula-tion.Methods:In this retrospective observational study based on real-world clinical data,a total of 204 monocular age-relat-ed cataract patients with a history of malignancy or receiving active antitumor therapy,who underwent phacoemulsification combined with intraocular lens implantation at the Department of Ophthalmology,Zigong First People's Hospital,between June 2022 and June 2025,were consecutively enrolled.General demographic data,malignancy-related history,surgical re-cords,and perioperative medication profiles were documented.Assessments were conducted at 3 days preoperatively and at 1,7,14,30,and 90 days postoperatively,including the Chinese Dry Eye Questionnaire and Ocular Surface Disease Index scoring,slit-lamp biomicroscopy,tear meniscus height measurement,tear film break-up time testing,corneal fluorescein staining scoring,Schirmer I test,and meibomian gland morphology and function evaluation.The incidence and temporal dis-tribution of surgery-related dry eye were evaluated.Patients with and without postoperative dry eye were matched at a 1:1 ratio using propensity score matching(PSM).Multivariable logistic regression analysis was employed to identify modifiable risk factors for surgery-related dry eye in age-related cataract patients with a history of malignancy.Results:Among the 204 patients,78(38.24%)developed surgery-related dry eye.The onset of dry eye predominantly occurred between postopera-tive days 1 and 7(64 cases,accounting for 82.05%),with a peak incidence on day 7(50 cases,24.51%).Univariate a-nalysis revealed that sex,age,tumor type,antitumor treatment modality,cumulative duration of antitumor therapy,history of systemic immune diseases,diabetes mellitus,thyroid dysfunction,high-altitude low-humidity environment,prolonged elec-tronic screen use,meibomian gland dysfunction,positive Ocular Surface Staining Test,meibomian gland secretion score,meibum viscosity grade,conjunctivochalasis grade,contact lens wear,surgical duration,use of preservative-containing eye drops,and combined use of multiple ophthalmic medications were associated with postoperative dry eye(all P<0.05).Af-ter PSM for sex,age,and history of prior ocular surgery,multivariable logistic regression analysis identified the following in-dependent modifiable risk factors for postoperative dry eye:head and neck radiotherapy(OR=4.925,95%CI:2.038～11.903),chemotherapy(OR=4.087,95%CI:1.782～9.374),cumulative antitumor therapy duration≥12 months(OR=3.722,95%CI:1.746～7.935),history of diabetes mellitus(OR=5.512,95%CI:2.215～13.718),mei-bomian gland dysfunction(OR=4.038,95%CI:1.586～10.278),meibum viscosity grade 3～5(OR=10.124,95%CI:3.786～27.066),conjunctivochalasis grade 3(OR=8.736,95%CI:3.231～23.618),contact lens wear(OR=10.458,95%CI:3.496～31.289),use of preservative-containing eye drops(OR=1.166,95%CI:1.055～1.289),and combined use of multiple ophthalmic medications(OR=10.015,95%CI:3.438～29.179)(all P<0.05).Con-clusion:The incidence of postoperative dry eye in age-related cataract patients with a history of malignancy or undergoing ac-tive antitumor therapy is 38.24%,with the first 7 days postoperatively constituting a critical window.Head and neck radio-therapy,chemotherapy,prolonged antitumor therapy,and perioperative ocular surface-related factors are significant modifia-ble risk factors for postoperative dry eye.Preoperative ocular surface screening and preconditioning,along with intensified dry eye prevention during the first postoperative week,are recommended for patients receiving radiotherapy or chemotherapy,those with diabetes,and those with severe meibomian gland dysfunction or abnormal meibum viscosity.