Outcomes of low-level light therapy before and after cataract surgery for the prophylaxis of postoperative dry eye: a prospective randomised double-masked controlled clinical trial.

BACKGROUND: Despite increasing evidence shows that optimising ocular surface before cataract surgery is fundamental in patients with pre-existing dry eye disease (DED) to achieve the desired postoperative outcomes, the prophylactic treatment of healthy patients undergoing surgery aiming at preventing iatrogenic DED is worth investigating. METHODS: This was a prospective, interventional, randomised, controlled, double-masked clinical trial. Patients were randomly assigned 1:1 to receive either low-level light therapy (LLLT) or sham treatment (LLLT with a power output <30%). Patients underwent two treatment sessions: 7±2 days before cataract surgery (T0) and 7±2 days after (T1). Outcome measures evaluated 30±4 days after surgery (T2) included Ocular Surface Disease Index (OSDI) questionnaire, non-invasive break-up time (NIBUT), tear meniscus height, meibomian gland loss (MGL) and redness score. RESULTS: Out of 153 patients randomised to receive LLLT (n=73) or sham treatment (n=80), 131 (70 men, 61 women, mean age 73.53±7.29 years) completed regularly the study. Patients treated with LLLT had significantly lower OSDI scores compared with controls at T1 and T2 (respectively, 7.2±8.8 vs 14.8±13.0 and 9.0±9.0 vs 18.2±17.9; both p<0.001), higher NIBUT values at T2 (12.5±6.6 vs 9.0±7.8; p=0.007) and lower MGL Meiboscore values at T1 (1.59±0.70 vs 1.26±0.69; p=0.008). Unlike controls, patients treated with LLLT had significantly lower OSDI scores and higher NIBUT values at T2 compared with T0 (respectively, 9.0±9.0 vs 21.2±16.1; p<0.001 and 12.5±6.6 vs 9.7±7.2; p=0.007). CONCLUSION: Two sessions of LLLT performed before and after cataract surgery were effective in ameliorating tear film stability and ocular discomfort symptoms. TRIAL REGISTRATION NUMBER: NCT05754437.

Serial Sessions of a Novel Low-Level Light Therapy Device for Home Treatment of Dry Eye Disease.

INTRODUCTION: This study aimed to evaluate the changes that a recently developed at-home device using low-level light therapy (LLLT) produced in signs and symptoms of patients with dry eye disease (DED) owing to meibomian gland dysfunction (MGD). METHODS: In this prospective study, patients with DED owing to MGD not successfully responding to first-line therapy (tear substitutes and eye lid hygiene) were treated with four serial sessions (every other day) of mask based on LLLT technology and dedicated for home use (my-mask®, Espansione Marketing S.p.A., Bologna, Italy). Non-invasive ocular surface examination was carried out by means of Keratograph 5M (Oculus, Wetzlar, Germany) before and after four mask sessions for the evaluation of (i) tear meniscus height (TMH); (ii) first and average non-invasive Keratograph breakup time (NIKBUT); (iii) meibomian gland loss (MGL). Ocular Surface Disease Index (OSDI) questionnaire was used to assess ocular discomfort symptoms. RESULTS: Overall, 17 patients (3 male, 14 female; mean age 61.47 ± 11.93 years) were enrolled and all of them regularly completed the entire cycle of four sessions without reporting any adverse event. The mean values of NIKBUT first and NIKBUT average increased significantly after treatment (from 5.29 ± 2.60 at T0 to 9.04 ± 3.49 s at T1 [P = 0.001] and from 9.40 ± 3.81 to 11.28 ± 2.81 s [P = 0.017]); in parallel, the mean value of TMH increased significantly from 0.27 ± 0.06 to 0.32 ± 0.09 mm (P = 0.029). Conversely, there were not statistically significant differences for MGL (P = 0.346). In addition, the mean value of OSDI score decreased after treatment (from 32.00 ± 7.96 at T0 to 20.71 ± 8.03 at T1; P < 0.001). CONCLUSIONS: One week of serial sessions of a newly developed LLLT device for home use significantly improved tear film production and stability along with ocular discomfort symptoms in patients with DED owing to MGD. These findings open up a new scenario for patients with MGD who can enjoy the unique benefits of LLLT at home.

Results of Descemet Stripping Automated Endothelial Keratoplasty for the Treatment of Late Corneal Decompensation Secondary to Obstetrical Forceps Trauma.

PURPOSE: To describe the clinical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in a series of patients affected by progressive endothelial cell loss leading to corneal decompensation with Descemet membrane (DM) breaks caused by obstetrical forceps trauma. METHODS: Seven amblyopic eyes of 7 patients affected by unilateral visual loss due to increasing corneal edema were included in the study. In all eyes, slit-lamp examination revealed typical DM breaks and diffuse corneal edema: these findings were compatible with a history of obstetrical forceps-assisted delivery. DSAEK was performed in all cases (in 3 eyes combined with phacoemulsification and intraocular lens implantation); visual acuity, refraction, corneal topography, and endothelial cell density were recorded preoperatively and 1 year after surgery. RESULTS: Visual acuity improved in all cases by at least 2 Snellen lines; topographic astigmatism lower than 2.5 diopters was associated with better visual recovery. No intraoperative or postoperative complications were reported, and the corneas remained clear throughout the follow-up. CONCLUSIONS: In eyes with endothelial decompensation secondary to DM breaks caused at birth by forceps injury, DSAEK can be performed uneventfully and restore cornea clarity. However, visual recovery is limited by the preexistent amblyopia, usually resulting from anisometropia and/or high-degree unilateral astigmatism. The results obtained in our patients suggest that low-degree astigmatism may be associated with better visual outcomes.

Red Reflex-Guided Big-Bubble Deep Anterior Lamellar Keratoplasty: A Simple Technique to Judge Dissection Depth.

PURPOSE: To report the results of a modified big-bubble deep anterior lamellar keratoplasty technique using the intraoperative red reflex to visualize the amount of residual stroma beneath the inserted cannula. METHODS: A total of 132 consecutive keratoconic eyes were included in this retrospective, noncomparative, interventional case series. Before starting surgery, pharmacologic mydriasis was induced in all eyes undergoing a big-bubble deep anterior lamellar keratoplasty procedure. After partial trephination of the recipient cornea, a spatula was inserted at the base of the incision and advanced into depth using as a reference the thin dark line seen in the red reflex ahead of the advancing tip; the stromal depth reached was measured using anterior segment optical coherence tomography. Finally, the spatula was exchanged for a 27-gauge cannula, and air was injected to create a big bubble. The stromal depth reached with the spatula, success rate of big-bubble formation, and complications were recorded. RESULTS: The big bubble was obtained in 118 of 132 eyes (89.4%). Of the remaining 14 eyes, 11 underwent completion of the procedure by manual dissection and 3 were converted to penetrating keratoplasty because the bubble burst while trying to enlarge it. Perforation did not occur in any case during cannula insertion. The average thickness reached with the stromal dissection was 64.3 ± 19.5 µm. CONCLUSIONS: The thin dark line, seen in the red reflex obtained with pharmacologic dilation, provides a useful and effective reference that can be used to visualize and judge the depth of dissection, thus allowing a safer and reproducible approach to the pre-Descemetic stroma.