Investigation into the influence of secondary suction within FLACS on the postoperative ocular surface and associated mechanisms.

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.