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Biological cleansing: Toward improving ocular surface surgical outcomes.
Rohit Shetty1,2,3, Nimisha R Kumar2, Pooja Khamar1
1Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India.
Indian Journal of Ophthalmology
|May 4, 2026
Summary
Preoperative biological cleansing reduces ocular surface inflammation, improving healing after eye surgery. Strategies like eyelid hygiene and immunomodulators mitigate complications such as dry eye and scarring.
Area of Science:
- Ophthalmology
- Ocular Surface Disease
- Surgical Outcomes
Background:
- Postoperative complications like dry eye, pain, and abnormal healing (fibrosis, ectasia) affect corneal, refractive, and cataract surgeries, even without typical risk factors.
- Subclinical ocular surface inflammation may underlie these suboptimal outcomes, with elevated inflammatory factors (e.g., IL-1β, TNFα, MMP-9) implicated.
- These factors disrupt ocular homeostasis by sensitizing pain pathways, destabilizing cell adhesion, and altering extracellular matrix deposition, leading to scarring or ectasia.
Purpose of the Study:
- To investigate the role of preoperative biological cleansing strategies in mitigating ocular surface inflammation.
- To identify methods for reducing inflammatory factors on the ocular surface before surgery.
- To enhance patient outcomes in ophthalmic surgery by modulating the ocular surface environment.
Main Methods:
- Review and synthesis of strategies for preoperative biological cleansing.
- Categorization of interventions including lubricants, eyelid hygiene, ocular washes, nutraceuticals, nonpharmacological therapies, topical immunomodulators, and lifestyle modifications.
- Examination of evidence for reducing ocular surface inflammatory factors through these methods.
Main Results:
- Various biological cleansing strategies have demonstrated a reduction in key inflammatory factors (IL-1β, IL-6, IL-17A, TNFα, IFNγ, MMP-9) on the ocular surface.
- These interventions address the molecular mechanisms contributing to postoperative complications.
- Successful reduction of inflammatory load is achievable through a combination of approaches tailored to the patient's condition.
Conclusions:
- Preoperative biological cleansing is a vital strategy for modulating ocular surface biology.
- Implementing these protocols can significantly improve postoperative outcomes in ophthalmic surgery.
- Reducing the burden of inflammatory factors preoperatively is key to preventing complications and enhancing healing.
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