The Effect Of Preoperative Dry Eye Treatment With Intense Pulsed Light With Meibomian Gland Expression On The Refractive Accuracy Of Cataract Surgery In Patients With Meibomian Gland Dysfunction- Related Dry Eye

To investigate the effects of preoperative intense pulsed light with manual meibomian expression (IPL-MGX) on the refractive accuracy of cataract surgery on dry eyes with meibomian gland dysfunction (MGD-related dry eyes).

Yokohama Tsurumi Chuoh Eye Clinic, Kanagawa, Japan

Fifty-six MGD-related dry eye cases planned for cataract surgery were analyzed. IPL-MGX (four times at 2-week intervals) was performed before preoperative examination. Axial length (AL), anterior chamber depth (ACD), corneal curvature (mean-K), tear break-up time (TBUT), superficial punctate keratopathy in the central cornea (C-SPK), corneal higher-order aberrations (HOAs), and predicted postoperative spherical equivalent (P-SE) were evaluated pre- and post-IPL-MGX. The postoperative subjective spherical equivalent (S-SE) was evaluated after one month. The absolute difference between S-SE and P-SE was considered an indication of P-SE accuracy. Changes in all the variables were assessed before and after IPL-MGX treatment.

No significant differences were observed in AL or ACD (p=0.85,0.56). The differences in meanK, TBUT, C-SPK, and HOAs were significant (p<0.01). P-SE accuracy based on post-IPL-MGX data was significantly higher than that based on pre-IPL-MGX data (p<0.01). P-SE accuracy was within 0.25 diopter (D) in 14.3% of pre- and 55.4% of post-IPL-MGX, within 0.5D in 55.4% of pre- and 92.9% of post-IPL-MGX, within 0.75D in 98.2% of pre-and post-IPL-MGX, and within 1.0D in 98.2% of pre- and 100% of post-IPL-MGX. In the range of 0.25 and 0.5 D, the accuracy of P-SE was significantly higher in post-IPL-MGX (0.01).

The present study illustrates that preoperative MGD-related dry eye treatment with IPL-MGX can be effective in improving tear film stability and ocular surface conditions, as demonstrated by the extension of TBUT and the decrease in HOAs and C-SPK scores, resulting in an improvement in preoperative corneal curvature measurement accuracy. These effects can increase the postoperative refractive accuracy. The results of the present study suggest that other types of modern physical MGD-related dry eye treatments may also increase postoperative refractive accuracy in cataract surgery. Therefore, preoperative MGD-related dry eye treatment is a promising choice for increasing postoperative patient satisfaction.