Efficacy and safety of intense pulsed light of upper and lower eyelids in Meibomian gland dysfunction: A prospective multicentric study.

PURPOSE: To demonstrate that intense pulsed light therapy (IPL) of the upper and lower eyelids with meibomian gland expression (MGX) is effective in improving dry eye disease due to meibomian gland dysfunction (MGD). METHODS: Patients with ocular discomfort (Ocular Surface Disease Index -OSDI- above 13) and signs of MGD were recruited. All patients underwent OSDI, visual acuity (VA), intraocular pressure, Schirmer test, meibography, non-invasive tear breakup time (NITBUT), slit-lamp examination (corneal and conjunctival staining, hyperemia, gland expressibility, and meibum quality), tear osmolarity and lipid layer thickness. IPL was performed with Optima IPL (Lumenis Ltd.) following a standardized protocol on upper and lower eyelids of both eyes, with inferior eyelid MGX. Patients received four sessions separated by two weeks each. Four weeks after, examinations were repeated. RESULTS: 160 patients (320 eyes) were included, of which 108 (67.5%) were women and mean age was 59.2 ± 15.08 (range 20-89). After four sessions, VA, OSDI, tear osmolarity, lipid layer thickness, NITBUT, hyperemia, corneal and conjunctival staining, gland expressibility, meibum quality, inferior eyelid Meiboscore and Schirmer test improved (all, p < 0.027). Changes in OSDI, initial and average NITBUT increased with dry eye disease severity (according to OSDI). Increased pre-treatment OSDI, hyperemia, corneal and conjunctival staining and Schirmer test were associated with an improvement in OSDI (all, p < 0.040). No adverse events were noted. CONCLUSIONS: The combination of IPL on upper and lower eyelids with MGX is safe and effective for the treatment of MGD. Patients with severe dry eye disease present greater improvements.

Characterization and Prediction of the Clinical Outcome of Intense Pulsed Light-Based Treatment in Dry Eye Associated to Meibomian Gland Dysfunction.

This non-comparative prospective case series was conducted to characterize the clinical impact of intense pulsed light (IPL)-based treatment in dry eyes associated to Meibomian gland dysfunction (MGD), defining the predicting factors for a successful outcome with this therapy in a large case series. A total of 390 eyes (195 patients, range: 23-93 years) received four sessions of Optima IPL system (Lumenis, Yokneam, Israel). Significant changes were observed in tear film osmolarity in both eyes (p < 0.001) and in meibum quality (p < 0.001), with more eyes showing clear or yellow secretions after therapy. Mean change in the ocular surface disease index (OSDI) was -8.61, ranging from -27.00 to 11.00. This change was significantly correlated with the baseline value of OSDI (r = -0.489, p < 0.001). The change in osmolarity correlated significantly with the baseline osmolarity in both eyes (right r = -0.636, left r = -0.620, p < 0.001). A linear predicting model of the change in OSDI with therapy was obtained: change OSDI = 10.99 - 0.35 × OSDI - 1.03 × NIBUTRE-LE (mean non-invasive break up time of right and left eye) - 2.03 × Meibum quality grade (p = 0.001; R2: 0.325). In conclusion, the improvement in symptomatology achieved with an IPL-based therapy can be predicted at baseline using a linear model considering the level of MGD and the magnitude of OSDI and NIBUT (non-invasive break-up time).

Clinical Outcomes with a Novel Extended Depth of Focus Presbyopia-Correcting Intraocular Lens: Pilot Study.

PURPOSE: To evaluate the clinical outcomes of cataract surgery with implantation of a novel model of extended depth of focus (EDOF) intraocular lens (IOL). METHODS: Pilot case series enrolling a total of 27 eyes of 16 patients (49 to 84 years) undergoing uncomplicated phacoemulsification cataract surgery with implantation of the EDOF IOL Synthesis PLUS (Cutting Edge, Montpellier, France). Near (UNVA, uncorrected near visual acuity; DCNVA, distance-corrected near visual acuity) and distance visual acuity (uncorrected and corrected distance visual acuity, UDVA and CDVA), monocular defocus curve and refractive outcomes were evaluated during a 3-month follow-up. RESULTS: Mean postoperative UDVA, UNVA and DCNVA were 0.11±0.17, 0.14±0.22 and 0.37±0.36 logMAR, respectively. A total of 84.6%, 91.7%, and 96.3% of eyes achieved postoperative UDVA, UNVA and CDVA of 0.20 logMAR or better. A total of 78.6% of eyes achieved postoperative DCNVA of 0.30 logMAR or better. Mean postoperative spherical equivalent was -0.76±0.53 D. The distance-corrected visual acuity was maintained on average over a value of 0.30 logMAR for the range of defocus levels between +1.00 and -1.50 D. CONCLUSION: The implantation of the Synthesis plus EDOF IOL after cataract surgery seems to provide functional levels of distance, intermediate and near visual acuity. The near visual performance with this new IOL might be significantly enhanced using a micro-monovision approach. The results of this pilot study should be confirmed in future clinical trials.

Outcomes of ZB5M angle-supported anterior chamber phakic intraocular lenses at 12 years.

PURPOSE: To evaluate the visual and refractive stability and the potential long-term risks associated with ZB5M phakic intraocular lens (PIOL) implantation. METHODS: A retrospective, non-randomized, cumulative clinical study was performed over 12 years in a consecutive group of 225 eyes implanted with the ZB5M PIOL. The main analyzed variables were visual and refractive outcomes (best spectacle-corrected visual acuity [BSCVA], uncorrected visual acuity [UCVA], and spherical equivalent), endothelial cell density, and postoperative complications. RESULTS: Mean preoperative spherical equivalent refraction was -17.23 +/- 7.69 diopters (D) and 12 years postoperatively it was -1.80 +/- 0.80 D. Mean BSCVA at 1- and 12-year follow-up was 0.38 +/- 0.19 and 0.57 +/- 0.18, respectively (Wilcoxon test, P < .001). At 12 years postoperatively, 3.5% of eyes lost > or = 2 lines of BSCVA. An initial 10.6% reduction in endothelial cell density was noted in the first year, followed by a mean annual rate of decrease of 1.78%. The cumulative incidence of pupil ovalization was 34.7% (78 eyes), and there was no statistical correlation with endothelial cell impairment. Bilateral hypertensive uveitis was diagnosed in 3 (1.33%) eyes. CONCLUSIONS: The ZB5M PIOL offers good refractive outcomes and stability in the long-term; however, endothelial cell loss increases over 12 years, requiring annual endothelial cell counts.

Late spontaneous resolution of a massive detachment of Descemet's membrane after phacoemulsification.

We report the spontaneous resolution of a massive detachment of Descemet's membrane 10 months after uneventful phacoemulsification. Diagnosis of the detachment was delayed because of severe corneal edema; thus, surgery was not performed. We propose that this complication of severe corneal edema after cataract surgery be considered and, given its excellent outcome, we recommend surgical treatment.