New advances in medical management of dry eye: optimizing treatment strategies for enhanced relief.

PURPOSE: Dry eye disease (DED) is a prevalent ocular surface disease that is conventionally characterized by tear film hyperosmolarity and instability. This review presents a summarized classification of DED, followed by a comprehensive discussion of the most recent topical and systemic medications and clinical recommendations for selecting the most appropriate option for each patient. METHODS: An extensive literature search was conducted on electronic databases, such as PubMed, Scopus, and Web of Science, using keywords including "dry eye syndrome," "ocular surface disease," "medical management," "artificial tears," "topical immunomodulators," and "meibomian gland dysfunction." RESULTS: The underlying reasons for DED can range from insufficient aqueous tear production to increased tear evaporation. Recent literature has provided a more in-depth understanding of the pathophysiology of DED by examining the tear film's lipid, aqueous, and mucin layers. However, despite these advancements, medical management of patients with symptomatic DED has not fully reflected this modernized knowledge of its pathophysiology. CONCLUSION: To develop a rationalized strategy for treating DED, it is crucial to have updated knowledge of therapeutic options, their mechanisms of actions, and indications based on the DED type and underlying causes.

Phantom Vision: A Benign, Intraoperative Visual Experience in Cataract Surgery.

The intraoperative experience of cataract surgery can be a source of fear and anxiety for many patients. We present a testimonial and illustrations of the intraoperative "phantom vision" experience of a 72-year-old commercial artist during her uncomplicated microincision cataract surgery. She describes a pleasant, colorful, dynamic intraoperative visual experience. First-hand reports from patients can be used in preoperative counseling to reduce anxiety associated with common "visual" phenomena experienced during cataract surgery.

Is Palpation Sufficient for Estimation of IOP Immediately Following Cataract Surgery?

The aim of this study was to evaluate the accuracy of standard palpation techniques and Barraquer tonometry relative to Tono-Pen for measurement of postoperative intraocular pressure (IOP) immediately following routine micro-incision cataract surgery (MICS). We conducted a prospective comparative analysis of postoperative IOP immediately after MICS in a single academic outpatient surgery center. A random block of 166 eyes that underwent MICS at our institution was selected for inclusion. Exclusion criteria consisted of any complications including posterior capsule rupture. IOP was measured immediately postoperatively, first with palpation or a Barraquer tonometer, then with a Tono-Pen handheld applanation tonometer. Measurements obtained by each method were compared. The mean difference between IOP measurements obtained by palpation and Tono-Pen was 10 mmHg, 95% confidence interval (CI; 8, 12); whereas the mean difference between IOP measurements obtained by Barraquer tonometer and Tono-Pen was 2 mmHg, 95% CI (1, 3). IOP measurements acquired via palpation differed from their corresponding Tono-Pen measurements by > 5 mmHg in 48.0% of cases compared to only 5.9% of measurements acquired using a Barraquer tonometer. Spearman correlation coefficient for measurements obtained by standard palpation and Tono-Pen was r = 0.397 (p < 0.01) compared to r = 0.774 (p < 0.01) for those obtained by Barraquer tonometer and Tono-Pen. In conclusion, palpation is not an accurate method for estimating IOP immediately after cataract surgery compared to Tono-Pen. Appropriate measurement and adjustment of IOP at the end of cataract surgery may decrease complications such as cystoid macular edema. In settings where a Tono-Pen is not readily available, Barraquer tonometry may serve as a reasonable and cost-effective alternative.

Immediate Postoperative Intraocular Pressure Adjustment Reduces Risk of Cystoid Macular Edema after Uncomplicated Micro Incision Coaxial Phacoemulsification Cataract Surgery.

PURPOSE: To determine the accuracy of visual estimation of immediate postoperative intraocular pressure (IOP) following microincision cataract surgery (MICS) and the effect of immediate postoperative IOP adjustment on prevention of cystoid macular edema (CME). SETTING: Ambulatory surgical center. METHODS: Prospective, randomized analysis of 170 eyes in 135 patients with MICS, performed in a Medicare approved outpatient ambulatory surgery center. Surgical parameters included a keratome incision of 1.5 mm to 2.8 mm, topical anesthetic, case completion IOP estimation by palpation and patient visualization of light, and IOP adjustment before exiting the operating theater. IOPs were classified into three groups: low (<16 mmHg), normal (16 to 21 mmHg), and elevated (>21 to 30 mmHg). IOP measurements were repeated 1 day after surgery. Optical coherence tomography (Stratus OCT, Zeiss) was measured at 2 weeks. An increase in foveal thickness greater than 15 µm was used to indicate CME. Statistical analysis was performed using one- and two-tailed Student's t-tests. RESULTS: Mean minimal foveal thickness averaged 207.15 µm in the low pressure group, 205.14 µm in the normal IOP group, and 210.48 µm in the elevated IOP group 2 weeks following surgery. CME occurred in 14 of 170 eyes (8.2%) at 2 weeks (low IOP, 35.7%; normal IOP, 14.2%; elevated IOP, 50.0%). Change in IOP from the operating theater to 1 day after surgery was within +/-5 mmHg in 54 eyes (31.7%), elevated by 6 to 15 mmHg in 22 eyes (12.9%), and elevated more than 15 mmHg in four eyes (2.3%). IOP was reduced by 6 mmHg to 15 mmHg in 39 eyes (22.9%) and reduced by more than 15 mmHg in nine eyes (5.3%). CONCLUSIONS: Immediate postoperative adjustment of IOP may prevent CME in MICS. Physicians can improve their ability to estimate postoperative IOP with experience in tonometry to verify immediate postoperative IOP. There are patient safety and economic benefits to immediate IOP adjustment in the operating theater. SYNOPSIS: Immediate postoperative IOP adjustment following cataract surgery before the patient leaves the operating theater may reduce the incidence of CME and provide patient safety and economic benefits.