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Thermal pulsation treatment before cataract surgery can improve refractive outcomes
Stabilizing the tear film preoperatively changed surgical management in 40% of cases.
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Visual outcomes improved in patients who underwent treatment of meibomian gland dysfunction before cataract surgery, according to a study.
Refractive targets within 0.25 D and 0.5 D were achieved when LipiFlow thermal pulsation treatment (Johnson & Johnson Vision) was done preoperatively and surgical management was re-planned after the treatment.
“Forty percent of the time I needed to change my surgical plan, which was huge,” Cynthia A. Matossian, MD, FACS, said.
The pilot study, conducted by Matossian Eye Associates and presented at the American Society of Cataract and Refractive Surgery annual meeting in San Diego, included 25 eyes of 23 patients with ocular surface disease and visually significant cataracts who opted for the MGD treatment before surgery.
Topography and keratometry (OPD-Scan III, Marco/Nidek) readings, as well as surgical plans, were compared before and after the MGD treatment.
Four weeks postoperatively, 88% of patients were within 0.25 D of their refractive target goals and 92% were within 0.5 D.
“Those are incredible outcomes,” Matossian said.
Astigmatism correction
Matossian said she typically plans a limbal relaxing incision (LRI) in eyes with 0.5 D to 1 D of astigmatism and a toric IOL in eyes with greater than 1 D of astigmatism.
In 28% of eyes, astigmatism correction was deemed necessary after MGD treatment when it was not part of the original management plan based on pre-thermal pulsation treatment data.
Eight percent of eyes for which the original surgical plan included LRI or toric IOL did not require either after the LipiFlow treatment.
“Their astigmatism was a pseudo-astigmatism from their dry eye disease and unstable tear film,” Matossian said. “Once stabilized, they had very little astigmatism that did not warrant a toric or an LRI.”
In the remaining 4% of eyes whose surgical plan was altered, an LRI rather than a toric IOL was deemed necessary due to a reduction in the magnitude of astigmatism, falling to between 0.5 D and 1 D.
“Had I used a toric IOL, I would have overcorrected their astigmatism,” Matossian said. “This pilot study showed me the critical importance of stabilizing the tear film to get good reliable data with which to calculate the IOL powers and plans for astigmatism management.”
More data pending
Johnson & Johnson Vision is conducting a larger study assessing cataract surgery before and after LipiFlow treatment. Matossian is conducting cataract surgeries for the study and noted the study recently met its enrollment goals and data should be available within the year. – by Robert Linnehan
- Reference:
- Matossian CA. Effect of thermal pulsation system treatment on keratometry measurements prior to cataract surgery. Presented at: American Society of Cataract and Refractive Surgery annual meeting; May 3-7, 2019; San Diego.
- For more information:
- Cynthia A. Matossian, MD, FACS, can be reached at Matossian Eye Associates; email: cmatossian@matossianeye.com.
Disclosure: Matossian reports she is a consultant and speaker for Johnson & Johnson Vision.