Preoperative risk factors for dry eye symptoms after cataract surgery: femtosecond laser-assisted cataract surgery (FLACS) versus standard cataract surgery (SCS)

Background: Despite technological advancements in cataract surgery, including Femtosecond Laser-Assisted Cataract Surgery (FLACS), postoperative dry eye disease (DED) remains a challenge, impacting patients’ quality of life. Identifying preoperative predictors of ocular discomfort could improve patient management. Methods: This exploratory prospective study compared the onset of DED symptoms and ocular surface changes after FLACS and standard cataract surgery (SCS). Twenty eyes were evaluated preoperatively and postoperatively, using Ocular Surface Disease Index (OSDI), Non-Invasive Break-Up Time (NI-BUT), Schirmer I Test, and Oxford Score. One-week OSDI was analyzed as the dependent variable using multivariable quantile regression (τ = 0.5), with baseline parameters (OSDI, Oxford score, Schirmer test, NI-BUT), age, BCVA, surgical technique, and cumulative dissipated energy (CDE) as predictors. Results: FLACS was associated with a transient worsening of OSDI at one week, which resolved by three months, whereas SCS showed a milder but more gradual increase. In multivariable analysis, baseline OSDI (β = 0.61, p < 0.001) and Oxford score (β = 5.42, p = 0.045) were independent predictors, while surgical technique and perioperative parameters were not significant. In a reduced model, both predictors confirmed their association. Subgroup analyses showed baseline OSDI as predictive only in FLACS. Conclusions: Preoperative ocular surface status emerges as the main determinant of early postoperative DED symptoms. Routine assessment of OSDI and Oxford scores may help identify at-risk patients and guide preventive strategies.