Opportunities for ocular surface management following microincision vitreoretinal surgery

Aim: to evaluate changes in ocular surface status in patients with various vitreoretinal pathologies (VRP) and dry eye (DE) following differentiated postoperative pharmacologic management. Patients and Methods: 80 patients with VRP (38 men, 42 women; mean age 63.2±7.1 years) and DE diagnosed on postoperative day 8 after microincision 25-gauge vitrectomy surgery (MIVS) were examined. Assessments were performed on postoperative day 8 (first control point), after completion of topical 0.5% moxifloxacin) and day 35 (second control point), including the Ocular Surface Disease Index (OSDI), tear breakup time (TBUT), lower tear meniscus height (LTMH), presence of epitheliopathy (Bijsterveld's xerosis index — XI), and presence of lipid deficiency associated with meibomian gland dysfunction (MGD). Group 1 included 25 patients who underwent surgery for macular hole and had evaporative DE (criteria: OSDI ≥ 13, TBUT <10 s, LTMH >200 μm). From postoperative day 8, in addition to standard therapy (0.1% dexamethasone and 0.09% bromfenac), they received 0.24% hyaluronic acid (HA) to stabilize the aqueous component of the tear film. Group 2 included 30 patients with operated rhegmatogenous retinal detachment and aqueous-deficient DE (criteria: OSDI ≥13, TBUT <10 s, LTMH <200 μm), who received, in addition to standard therapy, a fixed combination of 0.15% HA, polyethylene glycol (PEG) 8000, and vitamin B12 to restore the aqueous layer of the tear film. Group 3 included 25 patients operated for proliferative diabetic retinopathy with mixed DE in the presence of aqueous deficiency, MGDassociated lipid deficiency, and epitheliopathy (criteria: OSDI ≥13, TBUT <10 s, LTMH <200 μm, MGD, XI >3). These patients received standard therapy plus instillations of a fixed combination containing triglycerides, 0.24% HA, glycerin, and carbomer, along with topical 5% dexpanthenol gel to compensate lipid-aqueous deficiency and epithelial damage. Lubricating drops and gel were administered 3–4 times daily. Results: at the second time point, group 1 showed a significant increase in TBUT (from 6.5±0.7 to 7.9±0.4 s) and a reduction in OSDI (from 24.2±2.2 to 15.1±2.1). In group 2, TBUT increased significantly (from 5.7±0.6 to 7.1±0.5 s), along with LTMH (from 148.5±12.3 to 171.3±11.5 μm), while OSDI decreased (from 32.3±4.1 to 19.3±2.3). In group 3, significant increases in TBUT (from 4.9±0.3 to 6.5±0.5 s) and LTMH (from 132.5±10.3 to 160.4±12.1 μm) were observed, accompanied by reductions in XI (from 5.3±0.4 to 3.4±0.3) and OSDI (from 41.5±5.1 to 23.2±2.5). Conclusion: differentiated postoperative pharmacologic management in VRP and DE patients resulted in significant improvements in TBUT and OSDI in all groups. From postoperative day 8 after MIVS, the following may be recommended: for evaporative DE — 0.24% HA; for aqueous-deficient DE — a fixed combination of 0.15% HA, PEG 8000, and vitamin B12; and for mixed DE with aqueous deficiency, MGDassociated lipid deficiency, and epitheliopathy — a combination containing triglycerides, 0.24% HA, glycerin, and carbomer, along with 5% dexpanthenol gel. KEYWORDS: ocular surface, dry eye, vitrectomy, hyaluronic acid, polyethylene glycol 8000, triglycerides, carbomer, dexpanthenol. FOR CITATION: Yanchenko S.V., Malyshev A.V., Shonazarov A.A., Karapetov G.Yu., Al-Rashid Z.Zh. Opportunities for ocular surface management following microincision vitreoretinal surgery. Russian Journal of Clinical Ophthalmology. 2026;26(2):112–121 (in Russ.). DOI: 10.32364/2311-7729-2026-26-2-6

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