Effects of Lipiflow Treatment Prior to Cataract Surgery: A Prospective, Randomized, Controlled Study.

To investigate the effects of preoperative Lipiflow (Johnson & Johnson, Jacksonville, FL, USA) treatment before cataract surgery on meibomian gland dysfunction (MGD) and dry eye induced by surgery. DESIGN: Prospective, randomized controlled study. METHODS: This study comprised 124 eyes of 124 patients with planned surgery for senile cataract. Participants were randomly allocated into control and Lipiflow groups based on administration of Lipiflow treatment 3 weeks before cataract surgery. For meibomian gland (MG) evaluation, MG atrophy, degree of gland expressibility, and quality of gland secretions were examined at the baseline visit and 1 and 3 months postoperatively. Ocular surface parameters of tear film break-up time, Oxford corneal staining score, and tear film lipid layer thickness were measured at each visit. Ocular Surface Disease Index and Dry Eye Questionnaire were also assessed. RESULTS: The control group exhibited a significant decrease in MG expressibility, worsened meibum quality, decreased lipid layer thickness, and worsened corneal staining after cataract surgery. Also, dry eye symptom showed significant worsening. Conversely, the Lipiflow group showed significantly improved MG patency and meibum quality, increased tear film break-up time, and reduced corneal staining, and presented improved subjective outcomes reported on both Ocular Surface Disease Index and Dry Eye Questionnaire. The improvement of each parameter in the Lipiflow group showed a linear correlation with baseline MGD grade. In addition, patients without baseline MGD showed less worsening or improvement of MGD and dry eye induced by surgery, with preoperative Lipiflow treatment. CONCLUSIONS: Preoperative Lipiflow treatment conducted before cataract surgery may be a safe and effective intervention for relieving MGD and dry eye induced by surgery. It might be recommended not only for the patients with preoperative MGD but also for those without baseline MGD, to prevent the development of MGD and dry eye induced by ocular surgeries.

Effects of the re-esterified triglyceride (rTG) form of omega-3 supplements on dry eye following cataract surgery.

BACKGROUND/AIMS: To evaluate the clinical outcomes of the systemic re-esterified triglyceride (rTG) form of omega-3 fatty acids in patients with dry eye symptoms after cataract surgery. METHODS: This prospective comparative cohort study comprised 66 patients complaining of new-onset non-specific typical dry eye 1 month after uncomplicated cataract surgery. Subjects were randomly allocated into control and omega-3 groups based on administration of the systemic rTG form of omega-3 fatty acids for 2 months, in addition to use of artificial teardrop. Ocular surface parameters (Schirmer's test, tear break-up time, corneal staining score and matrix metalloproteinase-9 (MMP-9)) and subjective questionnaire results (Ocular Surface Disease Index (OSDI)) and Dry Eye Questionnaire [DEQ]) for dry eye were evaluated before and after omega-3 supplementation. RESULTS: Two months after omega-3 supplementation, the Oxford score was lower in the omega-3 group than in the control group. There was an improvement of subjective symptom scores of OSDI and DEQ in the omega-3 group (both p<0.05). The ratio of increasing MMP-9 level in the omega-3 group was lower than that in the control group (p=0.027). CONCLUSION: The rTG form of omega-3 supplementation might be related to reduction of ocular surface inflammation rather than secretion of tears, and it might be effective for non-specific typical dry eye after uncomplicated cataract surgery. TRIAL REGISTRATION NUMBER: NCT04411615.