Evaluation of Dry Eye Treatment with Sodium Hyaluronate- and Dexpanthenol-Containing Eye Drops on Ocular Surface Improvement after Cataract Surgery.

BACKGROUND: To clinically evaluate how dry eye symptoms in preoperatively diagnosed dry eye patients change with the use of sodium hyaluronate- and dexpanthenol-containing eye drops (HYLO CARE (HC), URSAPHARM Arzneimittel GmbH, Saarbruecken, Germany) after cataract surgery. The aim of the study was not to compare different eye drops but to implement standard treatment in patients with dry eye undergoing cataract surgery. The impact of treatment was evaluated using Symptom Assessment Tools for Dry Eye. METHODS: In this prospective, single-center, open-label clinical trial, 49 patients undergoing cataract surgery were included who showed signs and symptoms of dry eye disease assessed by the Symptom Assessment in Dry Eye (Visual Analogue Scale (VAS)) questionnaire, Ocular Surface Disease Index (OSDI), and fluorescein tear break-up Time (TBUT). Patients were instructed to apply HC three to four times a day for 5 weeks in the operated eye in addition to the standard postoperative topical anti-inflammatory regimen. The primary endpoint was the change in TBUT. Secondary endpoints were the assessment of the subjective symptoms (VAS), corrected distance visual acuity (CDVA), and slit-lamp examination including the corneal staining score, Schirmer test, and intraocular pressure. RESULTS: At 5 weeks after operation, the mean TBUT increased from 6.42 ± 1.57 s (s) to 7.81 ± 1.83 s in the per-protocol (PP) population (p > 0.001) and from 6.33 ± 1.64 s to 7.71 ± 2.05 s in the intention-to-treat (ITT) population (p < 0.001). There was a statistically significant decrease in all scores (p < 0.05) from the VAS questionnaire except for the tearing score (p = 0.062) at 5 weeks after operation. The mean total corneal staining score also decreased statistically significantly from 8.85 ± 2.49 before operation to 5.61 ± 3.37 at 5 weeks after operation on a 15-point scale. CONCLUSIONS: Controlled standardized dry eye treatment (with HC) improved tear film stability, ocular surface defects, and subjective symptoms of dry eye disease in patients 5 weeks after undergoing cataract surgery. Both the patient and physician assessments indicated high efficacy, tolerability, and a reliable safety profile, as indicated by the low number of at least possibly related adverse events (AE), suggesting its beneficial role in the postoperative management of the ocular surface (OS) in patients with dry eye symptoms prior to and after cataract surgery.

Refractive Outcomes of Cataract Surgery in Patients With Intrastromal Femtosecond Laser Treatment of Presbyopia (INTRACOR).

PURPOSE: To evaluate the outcomes of cataract surgery with intraocular lens (IOL) implantation in patients who underwent intrastromal femtosecond laser treatment of presbyopia (INTRACOR). METHODS: This was an interventional case series of 8 patients (10 eyes) who presented for cataract surgery 6.1 ± 3.2 years (mean ± standard deviation [SD]) after INTRACOR (Technolas Perfect Vision GmbH) treatment. A monofocal IOL was implanted in 9 eyes (7 patients) and a small-aperture IOL was implanted in 1 eye. The IOL power was calculated without adjustments using biometry obtained after the INTRACOR treatment. For additional calculations, keratometry obtained before the INTRACOR treatment was used. Postoperative examinations included visual acuity testing, manifest refraction, defocus curve, ocular biometry, corneal tomography, aberrometry, anterior segment optical coherence tomography, and slit-lamp examination. RESULTS: After the cataract surgery, the mean ± SD uncorrected distance visual acuity was 0.37 ± 0.17 logMAR, the corrected distance visual acuity was 0.10 ± 0.10 logMAR, and the manifest refraction spherical equivalent, adjusted to infinity, was +0.39 ± 0.63 diopters (D). Intermediate and near visual acuity, both uncorrected and distance-corrected, and distance-corrected defocus curves varied considerably among patients. Using biometry performed after INTRACOR, the traditional IOL power calculation formulas produced hyperopic outcomes, with the mean ± SD prediction error ranging from +0.72 ± 0.34 to +0.96 ± 0.41 D. Although the mean ± SD prediction error decreased (range: -0.34 ± 0.56 to -0.15 ± 0.53 D) when using keratometry obtained before INTRACOR, the accuracy remained low due to high variability. CONCLUSIONS: In patients with cataract who had previous INTRACOR treatment, IOL power calculation could be inaccurate, with a tendency toward hyperopic outcomes. These results require confirmation in more extensive studies. [J Refract Surg. 2023;39(10):676-682.].

Functional outcomes after bilateral refractive lens exchange with a continuous-range-of-vision intraocular lens.

PURPOSE: To clinically evaluate a diffractive continuous-range-of-vision intraocular lens (IOL) that combines bifocal and extended depth-of-focus technologies in refractive lens exchange (RLE) patients. SETTING: University eye clinic. DESIGN: Prospective interventional clinical study. METHODS: Bilateral implantation of the TECNIS Synergy IOL was performed during a RLE procedure in 28 patients. At 3 months postoperatively, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuities at 80 cm, and uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuities at 40 cm were assessed. Defocus curve testing and contrast sensitivity testing were also performed. RESULTS: Binocular UDVA and CDVA of 56 eyes (28 patients) were -0.06 ± 0.07 logMAR and -0.13 ± 0.05 logMAR, respectively. UIVA and DCIVA were -0.06 ± 0.05 logMAR and -0.08 ± 0.06 logMAR, and UNVA and DCNVA were -0.01 ± 0.07 logMAR and -0.04 ± 0.07 logMAR. The defocus curve revealed a visual acuity of 0.10 logMAR or better from +0.50 to -3.00 diopters (D). Photopic contrast sensitivity at spatial frequencies 3.0, 6.0, 12.0, and 18.0 was 1.68 ± 0.20, 1.77 ± 0.19, 1.45 ± 0.18, and 1.02 ± 0.19 log units, respectively. Mesopic contrast sensitivity at the same frequencies was 1.56 ± 0.20, 1.44 ± 0.25, 0.92 ± 0.38, and 0.44 ± 0.37, respectively. CONCLUSIONS: The Synergy IOL provided very good distance, intermediate, and near visual outcomes. A visual acuity of 0.10 logMAR or better was achieved from +0.50 to -3.0 D. Contrast sensitivity was within the normal range.

Clinical Evaluation of Reading Performance in Refractive Lens Exchange With a Diffractive Continuous-Range-of-Vision Intraocular Lens.

PURPOSE: Evaluation of reading performance with a novel presbyopia correcting intraocular lens (IOL) in refractive lens exchange using an electronic reading desk. DESIGN: Prospective interventional before-and-after clinical study. METHODS: In total, 56 eyes of 28 patients were included. Bilateral implantation of the TECNIS Synergy IOL (Johnson & Johnson Surgical Vision) during a bilateral delayed sequential refractive lens exchange procedure. Uncorrected and distance corrected reading acuity, reading distance, reading speed, and the smallest print size that could be read effectively at a set (40 cm/80 cm) and subjectively chosen near and intermediate distance were assessed using the Salzburg Reading Desk preoperatively and 6 months after surgery. RESULTS: Uncorrected near reading acuity increased from 0.61 ± 0.16 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.05 ± 0.09 logMAR postoperatively at the set near distance (40 cm) and from 0.60 ± 0.11 logMAR to 0.07 ± 0.08 logMAR at the subjectively preferred distance (39.6 ± 5.3 cm and 37.7 ± 4.3 cm). Uncorrected intermediate reading acuity was 0.39 ± 0.19 logMAR preoperatively and 0.08 ± 0.07 logMAR postoperatively at the set intermediate distance (80 cm) and 0.43 ± 0.21 logMAR preoperatively and 0.07 ± 0.08 logMAR postoperatively at the preferred intermediate distance (73.5 ± 9.5 cm and 73.3 ± 5.9 cm). CONCLUSIONS: Uncorrected intermediate and near reading function considerably improved after bilateral implantation of the TECNIS Synergy IOL. Patients preferred a closer near and intermediate distance to the set distances. However, reading function was comparable for the set and subjectively preferred distances.

Enlargement of main corneal incision: clinical intraindividual comparison of two preloaded intraocular lens injectors.

PURPOSE: To compare the enlargement of the clear corneal incision from IOL implantation with 2 different intraocular lens (IOL) injectors: the AutonoMe preloaded with the Clareon IOL and the Multisert preloaded with the Vivinex IOL. SETTING: The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. DESIGN: Prospective randomized clinical comparative study. METHODS: 96 eyes of 48 patients with cataract were intraindividually randomized to treatment with 1 of the 2 injectors. For Multisert eyes, the insert shield (IS) was used in the advanced position in 23 eyes. The initial incision was 2.2 mm, and intraoperative measurements of the incision size were made before and after IOL injection. 3 months postoperatively, keratometry and uncorrected (UDVA) and corrected (CDVA) distance visual acuities were assessed. RESULTS: Results are reported for 96 eyes of 48 patients. The mean incision enlargement was 0.213 ± 0.068 mm in the Multisert with the IS group, 0.265 ± 0.055 mm in the fellow eyes (AutonoMe) ( P < .05), 0.272 ± 0.060 mm in Multisert eyes treated without the IS, and 0.296 ± 0.066 mm for the fellow eyes (AutonoMe) ( P > .05). The mean absolute surgically induced astigmatism was 0.42 ± 0.23 diopters (D), 0.50 ± 0.25 D, and 0.44 ± 0.18 D in the Multisert with the IS, Multisert without the IS, and AutonoMe group, respectively ( P > .05). The UDVA and CDVA were comparable in all groups. CONCLUSIONS: The Multisert was associated with less wound enlargement than the AutonoMe. All groups had comparable functional outcomes. Therefore, the observed difference in incision enlargement may be of limited clinical relevance.