Eyeworld

SUMMER 2024 | EYEWORLD | 23 Contact Tapino: Paul.Tapino @pennmedicine.upenn.edu doses and frequencies of topical and systemic immunosuppressive therapies. For example, the authors reported that "the majority of eyes were treated with topical prednisolone (54.55%) or topical fluorometholone (25.45%)." However, more detailed data on whether these regimens were increased in dose or frequency prior to surgery would be helpful. With this data, further subgroup analyses could be performed, investigating whether there are certain dose thresholds recommended to promote periopera- tive ocular surface stabilization. Nonetheless, this was a valuable paper that reinforced the importance of caring for ocular surface disorders, not only to limit their morbidity, but also to improve the rate of posi- tive visual outcomes following cataract surgery. It provides support in favor of performing cat- aract surgery in patients with various condi- tions of the ocular surface, with the majority of patients reassuringly demonstrating improved BCVA following surgery without widespread exacerbation of their surface disease. Each eye should be evaluated carefully for ocular surface pathology and treated accordingly, as part of the preoperative and postoperative manage- ment of cataracts. in cases of active conjunctival inflammation. The benefits of improving the ocular surface prior to surgery seem to promote better surgical outcomes. While this study was unique in its inclusion of patients with a variety of ocular surface con- ditions, its sample size, lack of a control group, and retrospective design were certainly limita- tions. Only four eyes with ocular cicatricial pem- phigoid were included, for example, thus limit- ing this study's ability to draw many statistically meaningful conclusions about this subgroup. Along these lines, the authors reported that most patients with ocular cicatricial pemphigoid included in their cohort had excellent control of their ocular surface prior to surgery, thus limit- ing extrapolation of their findings to all patients with ocular cicatricial pemphigoid, particularly those with advanced disease. Another limitation was the lack of objective measures such as tear breakup time and tear osmolarity to quantify severity of disease. Future studies would benefit from including such objective measures, which are less prone to variability among multiple providers. Similarly, future studies may bene- fit from more detailed accounts of the specific treatment approaches to the preoperative stabi- lization of the ocular surface, including specific Visual outcome and postoperative complications of cataract surgery in patients with ocular surface disorders Aggarwal M, et al. J Cataract Refract Surg. 2024;50:474–480. n Purpose: To determine the visual outcome and postoperative complications of cataract surgery in patients with ocular surface disorders n Setting: Tertiary eyecare center in North India n Design: Retrospective observational study n Methods: Patients with various ocular surface disorders with stabilized ocular surfaces who underwent cataract surgery during this period and had a minimum postoperative follow-up of 6 weeks were included. The primary outcome measures were postoperative best corrected visual acuity at 6 weeks, best BCVA, and postoperative complications. n Results: The study included 20 men and 24 women. A total of 55 eyes were evaluated: 35 eyes with Stevens-Johnson syndrome (SJS), four eyes with ocular cicatricial pemphigoid (OCP), eight eyes with dry eye disease (DED), six eyes with chemical injury, and two eyes with vernal keratoconjunctivitis (VKC). The mean duration of ocular surface disorder was 33.9±52.17 months. The median preoperative BCVA was 2.0 (IQR, 1.45 to 2.0). The median BCVA ever achieved was 0.50 (IQR, 0.18 to 1.45) at 2 months, and the median BCVA at 6 weeks was 0.6 (IQR, 0.3 to 1.5). Maximum improvement in BCVA was noted in patients with DED and SJS and the least in OCP. Phacoemulsification was performed in 47.27% eyes with intraoperative complications noted in 9% of eyes. Postoperative surface complications occurred in 12 (21.82%) eyes. Other postoperative complications occurred in 9 (16%) eyes. n Conclusion: Cataract surgery outcome can be visually rewarding in patients with ocular surface disorders provided ocular surface integrity is adequately maintained preoperatively and postoperatively. References 1. Ram J, et al. Cataract surgery in patients with dry eyes. J Cataract Refract Surg. 1998;24:1119–1124. 2. O'Reilly P, et al. Age and sex profile of patients having cataract surgery between 1986 and 2003. J Cataract Refract Surg. 2005;31:2162–2166. 3. Erie JC, et al. Incidence of cata- ract surgery from 1980 through 2004: 25-year population-based study. J Cataract Refract Surg. 2007;33:1273–1277. 4. Behndig A, et al. One million cataract surgeries: Swedish National Cataract Register 1992–2009. J Cataract Refract Surg. 2011;37:1539–1545. 5. Narang P, et al. Cataract surgery in chronic Stevens-John- son syndrome: aspects and outcomes. Br J Ophthalmol. 2016;100:1542–1546. 6. Sangwan VS, et al. Cata- ract surgery in ocular surface diseases: clinical challenges and outcomes. Curr Opin Ophthal- mol. 2018;29:81–87.

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