Impact Of A Lipid-Containing Nanoemulsion Artificial Tear On Ocular Surface Status And Astigmatism Prediction In Cataract Surgery

Accurate astigmatism correction is critical in modern cataract surgery, particularly in patients receiving premium intraocular lenses (IOLs). Previous studies have demonstrated that ocular surface instability and the use of viscous artificial tears may influence keratometric measurements, potentially affecting IOL power and astigmatism planning. Systane COMPLETE (SC) is a lipid-containing nanoemulsion artificial tear designed to improve tear film stability and ocular surface hydration. This study aimed to evaluate the effects of SC on ocular surface optimization and astigmatism prediction in adults undergoing cataract surgery with pre-existing corneal astigmatism.

A prospective clinical study conducted at a tertiary medical center in Taipei, Taiwan.

This prospective study will enroll 65 adults scheduled for right-eye cataract surgery with corneal astigmatism ≥1.0 diopter (D). Patients with corneal pathology or prior use of artificial tears were excluded. All participants used SC for 1–2 months before and after cataract surgery. Assessments were performed at enrollment (baseline), within one week preoperatively, and one month postoperatively, including the Ocular Surface Disease Index (OSDI), routine ocular examination, keratometric measurements obtained by auto-refractometry, tomography (Pentacam), and optical biometry (Eyestar), and tear break-up time (TBUT) measured using Keratograph 5M.

Preliminary analysis included 36 patients (mean age 69.69 ± 9.97 years), comprising 19 men (52.7%). Baseline OSDI scores was ≤12 in 22 patients (61.1%). Mean corneal astigmatism measured by biometry before and after SC use was 1.453 ± 0.546 D and 1.504 ± 0.563 D, respectively (p = 0.652). Mean OSDI scores decreased from 11.17 ± 4.85 at baseline to 10.94 ± 4.77 after SC use and further improved to 5.39 ± 2.83 one month postoperatively (p < 0.001). Astigmatism prediction errors after SC use changed from −0.188 ± 0.601 D to −0.142 ± 0.447 D for J0 and showed a marginal reduction from 0.145 ± 0.314 D to 0.066 ± 0.285 D for J45 (p = 0.655 and 0.058, respectively). 

Preliminary results suggest that the lipid-containing nanoemulsion artificial tear may reduce dry eye symptoms and potentially improve astigmatism prediction in cataract surgery by optimizing the ocular surface. Further analyses with the complete study cohort are warranted to confirm these findings and clarify the role of lipid-based artificial tears in preoperative cataract assessment.