Effect of Preoperative Dry Eye Treatment with Intense Pulsed Light with Meibomian Gland Expression on the Refractive Accuracy of Cataract Surgery in Patients with Meibomian Gland Dysfunction-Related Dry Eye: A Single-Center, Prospective, Open-Label Study

Objective: This research seeks to investigate the effects of preoperative intense pulsed light with manual meibomian expression (IPL-MGX) on the refractive accuracy of cataract surgery on dry eyes with meibomian gland dysfunction (MGD-related dry eyes). Methods: Fifty-six MGD-related dry eye cases planned for cataract surgery were analyzed. IPL-MGX (four times at 2-week intervals) was performed before preoperative examination. Axial length (AL), anterior chamber depth (ACD), corneal curvature (mean-K), tear break-up time (TBUT), superficial punctate keratopathy in the central cornea (C-SPK), corneal higher-order aberrations (HOAs), and predicted postoperative spherical equivalent (P-SE) were evaluated pre- and post-IPL-MGX. The postoperative subjective spherical equivalent (S-SE) was evaluated after one month. The absolute difference between the S-SE and P-SE was considered an indication of P-SE accuracy. Changes in all the variables were assessed before and after IPL-MGX treatment. Results: No significant differences were observed in AL or ACD (p = 0.85, 0.56). The differences in mean-K, TBUT, C-SPK, and HOAs were significant (p < 0.01). P-SE accuracy based on post-IPL-MGX data was significantly higher than that based on pre-IPL-MGX data (p < 0.01). P-SE accuracy was within 0.25 diopters (D) in 14.3% of pre- and 55.4% of post-IPL-MGX, within 0.5D in 55.4% of pre- and 92.9% of post-IPL-MGX, within 0.75D in 98.2% of pre- and post-IPL-MGX, and within 1.0D in 98.2% of pre- and 100% of post-IPL-MGX. In the range of 0.25 and 0.5 D, the accuracy of P-SE was significantly higher in post-IPL-MGX (p < 0.01). Conclusions: Preoperative IPL-MGX considerably improved the predicted postoperative refraction accuracy in patients with MGD-related dry eye undergoing cataract surgery.