Preoperative Treatment For Ocular Surface Disease In A Cataract Surgery Patient Requiring Premium Multifocal Toric Intraocular Lenses (Iol's)

With an ageing population that is maintaining an active lifestyle the need for spectacle independence is growing. With increasing age comes co-pathology and ocular surface disease is a large consideration when undertaking cataract surgery. A poor tear film can result in unfavorable surgical outcomes and with premium IOLs this is more of a factor.

This case report describes the outcome of an 80-year-old female with poor preoperative ocular surface, bilateral cataracts and an insistence to be spectacle independent post-surgery. The patient was given preoperative treatment with AEON Protect Plus artificial tears and Fluorometholone (FML) eye drops. She later underwent bilateral cataract surgery with RayOne Trifocal Toric RA0613Z IOLs (Rayner).

OCL Vision, London, United Kingdom

This 80-year-old full time varifocal wearer presented with cataracts, a desire to undergo surgery and an insistence on spectacle independence.

Uncorrected distance visual acuity (UDVA) pre surgery was right eye (OD) 0.4 LogMAR correcting to 0.3 LogMAR in glasses. Left eye (OS) UDVA was 0.2 LogMAR and the same in glasses.

She had a poor non-invasive tear break up time (NITBUT) of 4 seconds in both eyes, bilateral cortical cataracts and meibomian gland dysfunction. Pentacam corneal tomography showed warpage due to a poor ocular surface and optical biometry showed corneal astigmatism of OD 0.50D@20 and OS 0.81D @151.

She was sent away with treatment to optimise her ocular surface with a daily warm compress, preservative-free AEON Protect Plus 0.3% crosslinked sodium hyaluronate (HA) 4 times a day and FML once a day in both eyes.

She returned 6 weeks later for repeat assessment where her NITBUT had improved to 7 seconds. Her Pentacam tomography showed greater accuracy and correlated with the biometry corneal astigmatism readings of OD 0.67D@25 and OS 1.16@165.

She underwent bilateral cataract surgery using RayOne Trifocal Toric RA0613Z IOLs.

At 2 weeks post-surgery her UDVA in each eye was 0.1 LogMAR with uncorrected near visual acuity (UNVA) 0.3 LogMAR. Binocular UDVA was 0.0 LogMAR and UNVA 0.3 LogMAR. She was delighted and did not complain about discomfort in her eyes. AEON repair with 0.15% HA, vitamins A and E was then added to her post operative regime.

Treating the ocular surface before lens-based surgery yields greater patient satisfaction from both a vision and comfort perspective. A healthy ocular surface means more accurate preoperative measurements resulting in more favorable surgical outcomes. It also enables surgeons to offer patients IOLs they would otherwise deem unsuitable.

In this case had we treated the patient based on initial biometry measurements the surgical outcome would have been less desirable.

By treating the ocular surface pre-surgery it reduces post-surgical symptoms and therefore further increases patient satisfaction. The use of artificial tears not only provides comfort but also helps to maintain a stable tear film for optimal clarity of vision.