Efficacy of Vector Thermal Pulsation treatment in reducing post-cataract surgery dry eye disease in patients affected by meibomian gland dysfunction.

Abstract

To evaluate the effect of a single LipiFlow vector thermal pulsation treatment (Johnson & Johnson) performed before cataract surgery in reducing signs and symptoms of postoperative dry eye disease (DED) in patients with mild-moderate meibomian gland dysfunction (MGD). Eye Clinic, Careggi Hospital, University of Florence, Florence, Italy. Prospective, unmasked, randomized, controlled clinical trial. This study included patients affected by age-related cataract and mild-moderate MGD, who were randomized in two groups: 1) A single LipiFlow treatment performed at 5 preoperative weeks; 2) Warm compresses and eyelid massages twice a day for one preoperative month (control group). Non-invasive break-up time (NI-BUT), Schirmer test, SPEED questionnaire and MG functionality parameters were evaluated at Visit 0 (5 preoperative weeks), Visit 1 (1 preoperative week), Visit 2 (1 postoperative month). Confocal microscopy of MG of lower eyelids was performed at visit 0 and visit 2. In the LipiFlow group (n=23) NI-BUT, SPEED questionnaire, MG functionality parameters significantly improved at Visit 1 (p<0.05) and Visit 2 (p<0.05) compared to baseline and remained stable after surgery. In the control group (n=23) they did not significantly improve after treatment, while worsened after surgery. Moreover, the changes in all parameters from baseline were significantly different between the two groups. Confocal microscopy imaging highlighted lower post-operative MG alterations in the Lipiflow group. A single preoperative LipiFlow treatment was effective in preventing post-cataract surgery DED in patients with mild-moderate MGD. After surgery, treated patients displayed a better ocular surface status compared to warm compresses.