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Evaluation of tear film instability pre and post corneal collagen cross-linking procedure in keratoconus patients

Advances in Ophthalmology & Visual System
Maria Ahsan, Misbah Sattar, Asifa Saba,Asima saba, Sara sonum, Asma batool

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Purpose: To evaluate tear film instability in keratoconus patients pre and post CXL procedure. Study design: Prospective cross-sectional study. Place and duration of study: Study was conducted at Al Ehsan Welfare eye hospital Lahore from 15th September, 2020 to 15th June, 2021.

Materials and methods: Tear break-up time (TBUT) test was used for determining the stability of the tear film out of 30 patients diagnosed with mild, moderate and severe keratoconus and tear film stability was assessed before and after CXL procedure by measuring tear break up time. Data was collected by using non-probability convenient sampling method. The patients were excluded if they had any previous dry eye syndrome, tear film instability, refractive surgery, other ocular surface abnormalities, cataract surgery and contact lens use before the CXL procedure. Pre and post-operative tear break up time was measured by performing TUBT test. Patients were selected between the age 25 to 35 years. In TBUT, sodium fluorescein dye was used and the tear film was observed with slit lamp under low magnification while the patient was instructed to avoid blinking while time was calculated until first dry spot appearance. SPSS version 21 was used for data analysis and Mcneemar’s test (kappa statistics) was applied with significance of p <0.05.

Results: Results shows that pre CXL tear breakup time of 22 patients was normal (10-15) sec while 8 patients were observed with borderline tear break up time less than 10 sec with percentage of 73.3% and 26.7 % respectively. Results of Post TBUT after one week of CXL procedure shows variation in values of tear break up time which shows decrease of tear break up time less than 10 sec of 12 patients and 18 patients with significantly reduced tear break up time less than 5 sec was recorded with percentage of 40.% and 60. % respectively. After two weeks of procedure it was recorded that tear break up time of 4 patients was normal (10-15 sec) post tear break up time, while tear break up time of 18 patients was noted borderline (<10 sec) and 8 patient with reduced post tear break up time (<5sec) with percentage of 13.3 % , 60 % and 26.7% respectively. After one month of CXL the tear break up time was significantly improved as compared to one and two weeks of postoperative procedure of CXL as the corneal epithelium was regenerated. Conclusion: This study concludes that tear breakup time was significantly reduced after CXL procedure. TBUT was normal before the CXL but after CXL due to destruction of corneal epithelium the TBUT was reduced. Thus results reveals instability of tear films occurs after CXL procedure.


CXL, TBUT, keratoconus, corneal epithelium, fluorescein strips