Dry eye treatment optimization in patients prior to refractive surgery

Abstract

Purpose. To evaluate the effectiveness of dry eye syndrome (DES) treatment in patients with meibomian gland dysfunction (MGD) before refractive surgery.Materials and methods. We examined 48 women (aged 29.6 ± 3.9 years) with myopia, DES, and MGD of noninfectious etiology before performing LASIK. Group 1 of these patients received presurgical correction of DES for 2 months, including instillation of 3 % trehalose as a bioprotector (Thealoz®; 3–4 times a day); application of 5 % dexpanthenol in the conjunctival cavity (before going to bed); eyelid hygiene (2 times per day), which included cleaning (Theagel®), warm compresses on eyelid area, massage of eyelid margin (Blephaclean wipes). Group 2 only received bioprotective and reparative therapy for 2 months. Testing included a standard ophthalmological examination; assessment of DES symptoms (OSDI scale, points); BUT test (sec) and Schirmer-1 test (Sh-1, mm); measuring the height of the lower tear meniscus (optical coherence tomography, μm); lissamine green staining with calculation of xerosis index by Bijsterveld (points); assessment of MGD severity (points). Processing of the results included calculation of M ± s; Wilcoxon t-test, Mann Whitney U-test.Results. A positive change of OSDI (decrease from 31.9 ± 2.9 to 8.71 ± 1.1 points), xerosis index (decrease from 4.71 ± 0.5 to 2.1 ± 0.3 points) and BUT test (increase from 4.14 ± 0.53 to 8.66 ± 0.93 sec) was significantly stronger in patients of group 1 (p < 0.05) in comparison with patients of group 2 (decrease in OSDI from 33.2 ± 3.1 to 15.6 ± 2.4 points; decrease of xerosis index from 4.75 ± 0.50 to 3.7 ± 0.5 points; BUT increase from 4.21 ± 0.47 to 6.05 ± 0.73 sec). Apparently, this was caused by a significant decrease in the severity of MGD (from 2.1 ± 0.3 to 0.9 ± 0.2 points) and a decrease in the severity of lipid deficiency due to eyelid hygiene in patients of group 1. In group 2, MGD severity change proved unreliable. Change of Sh-1 and the height of the lower tear meniscus was unreliable in all cases. Conclusion. The inclusion of eyelid hygiene (Theagel and Blephaclean) in the pre-surgery preparation of patients with DES and MGD leads to a more significant correction of eye surface condition compared to isolated bioprotective and reparative therapy, thus providing an opportunity of more favorable conditions for carrying out surgical correction of ametropia.

Long-term results in patients with iris-fixated foldable phakic intraocular lenses for myopia and astigmatism

“…Furthermore, it is necessary to alert patients to avoid trauma, such as that caused if rub their eyes, and to properly treat predisposing conditions, such as dry eye and allergies. 10–13

WHAT WAS KNOWN

Long-term results of patients with Artisan Myopia and Artisan Toric pIOLs are well described in the literature.Regarding Artiflex pIOLs, to our knowledge, there are few published studies reporting outcomes at 5 or more years.

WHAT THIS PAPER ADDS

Long-term results demonstrate that the implantation of Artiflex pIOLs is a stable, predictable, and effective procedure even at 15 years of follow-up.Anterior chamber depth lower than 3.00 mm should be an exclusion criterion for Artiflex pIOL implantation.Safety criteria according to the age of implantation should take into account the annual loss of endothelial cells (1.20% per year at 15 years of follow-up) to ensure the necessary corneal health to endure future cataract surgery.

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“…Furthermore, it is necessary to alert patients to avoid trauma, such as that caused if rub their eyes, and to properly treat predisposing conditions, such as dry eye and allergies. [10][11][12][13] WHAT WAS KNOWN Long-term results of patients with Artisan Myopia and Artisan Toric pIOLs are well described in the literature. Regarding Artiflex pIOLs, to our knowledge, there are few published studies reporting outcomes at 5 or more years.…”

The Choice of Dry Eye Therapy Depending on Ocular Surface Condition

“…Данные ранее проведенных исследований дают основание считать, что у пациентов подгруппы 1.3 (инстилляции 3 % трегалозы 3 раза в сутки в сочетании с аппликациями декспантенола на ночь) в результате двух месяцев терапии было достигнуто состояние глазной поверхности (тест Норна ≥7 с; табл. 1), позволяющее безопасно и эффективно выполнять рефракционные лазерные вмешательства на роговице (при условии продолжения биопротекторной терапии в послеоперационном периоде) [5,6,18]. С нашей точки зрения, у пациентов подгруппы 2.2 слезозаместительную и кератопротекторную терапию (инстилляции 0,15 % натрия гиалуроната и 3 % трегалозы 4 раза в сутки, аппликации витамина А на ночь) необходимо продолжать, поскольку временной интервал, необходимый для достижения состояния глазной поверхности, позволяющего безопасно проводить лазерные рефракционные вмешательства на роговице (тест Норна ≥7 с) у пациентов с фоновым предоперационным ССГ средней тяжести, составляет не менее трех месяцев [18].…”

“…Так, у части наблюдавшихся было зафиксировано снижение выраженности симптома «дворников», что соотносится с результатами ранее проведенных нами исследований и может быть связано с влиянием заместительной и кератопротекторной терапии на состояние эпителия краев век [18]. Однако ни в одной из подгрупп данная положительная тенденция не была статистически достоверной, а полученные результаты характеризовались большой дисперсией.…”