Eyeworld

Supported by Alcon Laboratories Inc., Allergan Inc., Shire Pharmaceuticals, TearLab, and TearScience 5 The perils of ignoring OSD in refractive cataract patients T o obtain the optimal results from cataract and refractive surgery, it is important to detect and treat OSD before performing preoperative measurements. OSD can affect measurement accuracy, impacting postoperative visual outcomes. In case 1, a 65-year-old man with visually significant cataracts, without a history of previous ocular surgery or disease, complained of burning and itching eyes that were worse in the morning. On the dry eye questionnaire, he noted fluctuating vision, chronic "red eyes," and watering eyes. Case 1. Meibomian gland disease; note thickened meibum and gland dropout Case 2: Lissamine green staining of the intrapalpebral bulbar conjunctiva Keratometry and topography showed irregular astigmatism. Osmolarity was 310 and 328; MMP-9, negative; tear break-up time, 5 seconds; and Schirmer's, 12/16 mm. During the examination, mild inferior corneal staining occurred, and inspissation of the meibomian glands and thickened meibum were noted. Meibography showed truncation and loss of meibomian glands. Meibomian gland disease was diagnosed, and the patient was treated with artificial tears, topical azithromycin qhs, oral omega-3 supplementation, and LipiFlow thermal pulsation therapy. Preoperative biometry was performed 1 month later. In case 2, a 64-year-old woman with visually significant cataracts was interested in a multifocal IOL. She had severe dry eye symptoms that began acutely several years previously. She had been treated with numerous artificial tears and topical cyclosporine. She also had severe dry mouth and mild aches and pains that began before the dry eye symptoms. Her osmolarity was 318 and 327; MMP-9, positive; tear break-up time, 12 seconds; meibomian gland expression, normal; and Schirmer's, 1/4 mm; she showed severe corneal and conjunctival staining. In addition, her Sjö test had positive results. Primary Sjögren's disease with severe aqueous deficiency dry eye was diagnosed. She was treated with loteprednol 0.5% qid. Two weeks after topical steroid induction, topical cyclosporine A was started. Punctal occlusion was performed on all lids. We educated the patient about Sjögren's disease and referred her to a rheumatologist for a systemic workup and possible systemic therapy and to a dentist for an examination and oral hygiene recommendations. Surgery was delayed until preoperative testing results improved. Because she had persistent corneal staining, we did not recommend a multifocal IOL.

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