Next Article in Journal
The Conditions of Survival of Patients with a SARS-CoV-2 Infection Burdened by Cardiovascular Pathologies in a Temporary Hospital in Gdańsk in 2021 and 2022
Previous Article in Journal
Leucine-Rich Alpha-2 Glycoprotein 1 as a Biomarker for Evaluation of Inflammatory Bowel Disease Activity in Children
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
JCM
Volume 14
Issue 8
10.3390/jcm14082805
jcm-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

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

by
Tatsukata Kawagoe
1,
Yuki Mizuki
1,
Miki Akaishi
1,
Masaki Takeuchi
1,
Kazuro Yabuki
2,
Seiichiro Hata
3,
Akira Meguro
1,
Nobuhisa Mizuki
1 and
Takeshi Teshigawara
1,4,5,*
1
Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama 236-0004, Japan
2
Department of Ophthalmology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama 234-0054, Japan
3
Department of Ophthalmology, Yokohama Sky Eye Clinic, Yokohama 220-0011, Japan
4
Department of Ophthalmology, Tsurumi Chuoh Eye Clinic, Yokohama 230-0051, Japan
5
Department of Ophthalmology, Yokosuka Chuoh Eye Clinic, Yokosuka 238-0008, Japan
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(8), 2805; https://doi.org/10.3390/jcm14082805
Submission received: 28 February 2025 / Revised: 7 April 2025 / Accepted: 16 April 2025 / Published: 18 April 2025
(This article belongs to the Section Ophthalmology)
Browse Figures
Review Reports Versions Notes

Abstract

:
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.

1. Introduction

Cataract surgery replaces patients’ crystal lenses with artificial intra-ocular lenses (IOL). Approximately 10% of patients are dissatisfied with the outcomes of cataract surgery [1,2]. Blurred vision is the most common cause of postoperative dissatisfaction (68%), with postoperative refractive error often being a major contributing factor [3,4,5].
Postoperative refractive outcomes depend on accurate IOL power calculations and preoperative biometric measurements such as axial length (AL), anterior chamber depth (ACD), and keratometry, which are the most crucial factors influencing postoperative refractive outcomes [6,7].
Owing to advancements in optical coherence tomography (OCT), the precision of AL and ACD measurements has improved. Nonetheless, the precision of keratometry measurements has not significantly improved [8]. Inaccurate keratometry measurements are mainly due to ocular surface irregularities and tear film instability, both of which are mainly caused by dry eyes [9,10,11], potentially inducing intra-patient discrepancies in keratometry measurements [12,13,14]. These conditions can also be caused by meibomian gland dysfunction (MGD)-related dry eyes [15].
A previous study reported a disparity of up to 0.5 D in the results of IOL power calculations among patients with dry eyes at different visits [16]. A preoperative error of 0.5 D in IOL power calculation can lead to a postoperative refractive error of as much as 1.17 D, which has a remarkable effect on postoperative visual outcome [17].
Concerning the epidemiology of patients with dry eyes scheduled for cataract surgery, the Prospective Health Assessment of Cataract Patients’ Ocular Surface (PHACO) study reported that rapid tear break-up time (TBUT) was observed in approximately 60% of patients planning cataract surgery, and central corneal staining was seen in approximately 50% of these patients [18]. MGD was defined as abnormal meibum composition and secretion [19]. Approximately 86% of patients with dry eyes have been reported to have concomitant MGD [19]. Other studies indicated that MGD-related dry eye prevails in approximately 75% of patients planning cataract surgery [20,21].
Intense pulsed light (IPL) is commonly used to treat skin conditions such as rosacea and acne [22]. Extensive research has demonstrated the usefulness of IPL for MGD-related dry eye [23,24,25]. Furthermore, the use of IPL or manual meibomian expression (MGX) alone is not as effective as a combination of these techniques [26,27].
Based on these reports, it is speculated that preoperative IPL-MGX treatment of MGD-related dry eye in patients preparing for cataract surgery can alleviate their tear film stability and ocular surface conditions, leading to improved postoperative refractive accuracy.
Therefore, the primary objective of this study was to investigate the efficacy of preoperative treatment for MGD-related dry eye using IPL-MGX in improving the refractive accuracy of cataract surgery.

2. Materials and Methods

2.1. Study Design and Patients

This prospective, open-label study conducted at a single center involved Japanese patients scheduled for cataract surgery who had been diagnosed with dry eye and MGD. The STROBE checklist for cross-sectional studies was used to write this research paper [28]. The following inclusion and exclusion criteria were used to select patients diagnosed with cataract. The inclusion criteria were as follows: (1) The diagnostic criteria for dry eye established in Japan, encompassing TBUT ≤ 5 s and dry eye symptoms such as eye discomfort and visual disturbance, were used to diagnose dry eye [29]. The Japanese version of the Ocular Surface Disease Index was used to assess dry eye symptoms [30]. In this study, dry eye symptoms were not quantified, as this was not a requirement. (2) Patients were also diagnosed with hyposecretory MGD using the Japanese MGD diagnostic criteria, which included the following three factors: findings indicating orifice blockage, abnormalities around the orifices, and the presence of symptoms [20].
Irregularities in the area surrounding the orifices were evaluated as abnormal if one of the following criteria was observed: anterior or posterior mucocutaneous junction replacement, lid margin irregularity, or vascular engorgement. If both meibomian gland orifice abnormalities and reduced meibomian secretion were observed, blockages were assessed as positive [20].
The exclusion criteria were as follows: (1) previous use of medications or punctual plugs before the study onset; (2) patients with skin, blepharitis, or dermatological problems; (3) history of contact lens use; (4) previous ocular surgery, trauma, or inflammation, corneal dystrophy or scarring, or any disorder that may lead to irregularities of the ocular surface; (5) patients with diabetes; (6) patients who opted for alternative preoperative dry eye treatments after enrollment.

2.2. MGD-Related Dry Eye Treatment

The allocation of IPL-MGX to either the right or left eye was determined using permuted block randomization.
IPL-MGX was performed four times preoperatively by the same ophthalmologist at 2-week intervals. During the treatment period, no type of dry eye medication was allowed. Possible adverse effects of IPL, such as redness, swelling, blistering, and scarring, were assessed at each treatment session by the ophthalmologist.

2.3. IPL-MGX Procedure

In all cases and procedures, the IPL device (M22 IPL; Lumenis Be, Yokne’am Illit, Israel) was operated in triple pulse sequence mode with the following settings: pulse duration of 6 ms, pulse delay of 50 ms, energy fluence ranging from 11 to 16 J/cm2, and a filter wavelength of 590 nm.
Patients were instructed to keep both eyes closed, and their eyes were protected using IPL-Aid eye shields (Honeywell Safety Products, Smithfield, RI, USA). After applying gel to the treatment area on the skin, the procedure was carried out in two steps.
  • Step 1: Twelve pulses were delivered using a double-pass technique to the infraorbital and lower eyelid area with a 15 × 35 mm guide light (Figure 1) [31].
  • Step 2: Three pulses were applied using a single-pass technique to both the upper and lower eyelids with an 8 × 15 mm guide light (Figure 2) [31].
MGX was performed approximately 10 min after IPL treatment on both the upper and lower eyelids using meibomian gland forceps (Charmant, Fukui, Japan). To minimize discomfort during the procedure, a 0.4% oxybuprocaine hydrochloride ophthalmic solution was administered.

2.4. Examination of Ocular Surface Conditions, Biometric Parameters (AL, ACD, and Mean-K), and Accuracy of Predicted Postoperative Spherical Equivalent

TBUT was used to assess tear film stability [32,33], while superficial punctate keratopathy in the corneal center (C-SPK) and higher-order aberrations (HOAs) were used to assess ocular surface conditions [34,35,36,37]. The AL, ACD, and mean-K are considered the most important parameters for IOL power calculations [38,39]. The accuracy of the predicted postoperative spherical equivalent (P-SE) was evaluated by calculating the absolute difference between the subjective postoperative spherical equivalent (S-SE) and the P-SE, as measured using the IOLMaster 700 (Carl Zeiss Meditec AG, Jena, Germany). These variables were examined at baseline and approximately 1 week after the four IPL-MGX treatments. Surgery was performed approximately one week following preoperative examinations.
TBUT, HOAs, C-SPK, and the P-SE accuracy were compared before and after dry eye treatment with IPL-MGX to assess the impact of IPL-MGX on tear film stability, ocular surface conditions, and refractive accuracy.
TBUT and C-SPK were evaluated using a fluorescein dye. A fluorescein strip (Showa Yakuhin Kako Co., Tokyo, Japan) was moistened with saline, and any excess fluid was carefully removed prior to assessment. A strip was then placed on the inferior bulbar conjunctiva. The mean TBUT was calculated by measuring at two time intervals [40]. The extent of central corneal staining was assessed using the grading method established by the National Eye Institute/Industry Workshop [41]. C-SPK was scored on a scale from 0 to 3, as follows: 0 = none, 1 = mild, 2 = moderate, and 3 = severe. HOAs within a 4 mm corneal center were analyzed using CASIA 2 (Tomey Corporation, Nagoya, Japan), which offered a precise image of the optical status of the cornea using Zernike polynomials. HOAs were quantified as the total magnitude of third- to sixth-order aberrations and calculated using the root mean square method [42]. The AL, ACD, and mean-K were analyzed using an IOLMaster 700. Barrett Universal II was used to calculate the P-SE [43]. The same experienced and certified technician checked the subjective postoperative visual acuity 1 month postoperatively using the Early Treatment Diabetic Retinopathy Study Chart. The absolute difference between the P-SE and S-SE was considered the value of the accuracy of the P-SE (i.e., postoperative refractive accuracy).

2.5. Statistical Analysis

SPSS software (v. 29.0; IBM SPSS Statistics, Armonk, NY, USA) was used for all statistical analyses. A p-value of less than 0.05 was considered indicative of statistical significance. All variables were compared before and after IPL-MGX treatment. The normality of variable distributions was assessed using the Shapiro–Wilk test, which showed a non-normal distribution for all variables, apart from ACD. Additional statistical analyses were performed based on the normality test results.
The Wilcoxon signed-rank test was employed to compare TBUT, C-SPK, HOAs, AL, mean-K, and P-SE accuracy before and after dry eye treatment with IPL-MGX [44]. The ACD was compared using a paired-t test [45]. P-SE accuracy in both the pre- and post-dry eye treatment was broken down into four categories: within 0.25 diopters (D), within 0.5D, within 0.75D, and within 1.0D. The relative proportions of each category were compared using a chi-square test [46].
G*Power (v. 3.1.9.7) was used to perform a post hoc analysis to assess the power of sample size. The post hoc power analysis indicated that the sample size (n = 56) provided 99.9% statistical power to detect a large effect size (Cohen’s d = 0.86) at a significance level of 0.05.

3. Results

3.1. Baseline Patient Characteristics

A total of 56 eyes of 56 subjects (26 male and 30 female) with MGD-related dry eye were selected for IPL-MGX treatment prior to preoperative examination for cataract surgery. The mean age was 74.4 ± 6.3 (range, 59–85). The nurses ensured that all patients followed all regiments in this study. Possible adverse effects of IPL, such as redness, swelling, blistering, and scarring, were not observed in any patient throughout the study.

3.2. Biometric Variables Pre- and Post-IPL-MGX Treatment

Table 1 shows the relevant biometric variables for the IOL power calculation pre- and post-IPL-MGX treatment. No significant difference was observed in the AL and ACD comparing the pre-IPL-MGX and post-IPL-MGX treatments (p = 0.86 and 0.56, respectively) (Table 1). However, a significant difference was observed in the mean-K between the pre-IPL-MGX and post-IPL-MGX treatments (p < 0.01) (Table 1).

3.3. Tear Film Stability and Ocular Surface Conditions Pre- and Post-IPL-MGX Treatment

Table 2 shows variables indicating tear film stability and ocular surface conditions in pre-and post-IPL-MGX treatments. Regarding tear film stability, the TBUT in post-IPL-MGX was significantly longer than in the pre-IPL-MGX treatment (p < 0.01) (Table 2). Concerning ocular surface conditions, significant improvements in both C-SPK and HOAs were observed following IPL-MGX treatment (both p < 0.01) (Table 2).

3.4. Postoperative Refraction Accuracy Based on Pre- and Post-IPL-MGX Treatment Data

Table 3 shows P-SE accuracy based on pre- and post-IPL-MGX treatment data. P-SE accuracy post-IPL-MGX treatment was significantly improved compared to that of pre-IPL-MGX treatment (p < 0.01) (Table 3).

3.5. Accuracy Within 0.25D, 0.50D, 0.75D, and 1.00D of Postoperative Refraction Based on Pre- and Post-IPL-MGX Treatment Data

Figure 3 shows P-SE accuracy within 0.25D, 0.50D, 0.75D, and 1.00D based on pre- and post-IPL-MGX treatment data. P-SE accuracy in each category was as follows: within 0.25D, 14.3% based on pre-treatment data and 55.4% based on post-treatment data; within 0.5D, 55.4% based on pre-treatment data and 92.9% based on post-treatment data; within 0.75D, 98.2% based on both pre- and post-treatment data; and within 1.0 D, 98.2% based on pre-treatment data and 100% based on post-treatment data (Figure 3).
P-SE accuracies within 0.25D and 0.50D based on the post-IPL-MGX treatment were significantly higher than those based on the pre-IPL-MGX treatment (both p < 0.01) (Figure 3).

4. Discussion

To the best of our knowledge, no previous study has revealed that preoperative IPL-MGX treatment of MGD-related dry eye improves postoperative refractive accuracy in cataract surgery. The current study found a remarkable improvement in P-SE accuracy after preoperative MGD-related dry eye treatment with IPL-MGX.
Previous studies indicated comparable results with eye drop dry eye treatments, such as a 5% lifitegrast and rebamipide ophthalmic solution [47,48]. However, the patients in these studies were diagnosed with dry eye but not MGD-related dry eye. Therefore, the dry eyes were merely treated with the eye drops. In contrast, all patients in the present study were diagnosed with both dry eye and MGD and were treated with IPL-MGX.
The most common types of MGD are obstructive and hyposecretory. A characteristic of these meibomian gland derangements is blockage at the duct ending [49]. In MGD, changes in tear film lipid composition can occur due to anatomical degeneration and pathophysiological changes, which can accelerate evaporative dry eye [50]. Epidemiologically, approximately 75% of patients planning cataract surgery have MGD-related dry eyes [20,21].
Multiple studies reported the negative impact of MGD-related dry eye on preoperative biometric measurements in cataract surgery [51,52,53]. Covita et al. demonstrated that more severe MGD can cause a shorter TBUT [54], indicating tear film instability [32,33]. Previous studies have concluded that tear film instability induces the tear film to break up quickly and thicken irregularly [55], which can increase HOAs and C-SPK in dry eyes [37,56,57], indicating poor ocular surface conditions [34,37]. These poor ocular surface conditions negatively affect the accuracy of preoperative corneal curvature measurements [58].
Regarding modern physical treatment for MGD-related dry eye, LipiFlow thermal pulsation, IPL, and Tixel were established by Lane et al. [59], Toyos et al. [23], and Safir et al. [60], respectively.
The efficacy of LipiFlow thermal pulsation and IPL on the improvement of tear film stability and ocular surface conditions has been reported [61,62], but not for Tixel. Furthermore, improvements in the accuracy of corneal curvature measurements with preoperative treatment for MGD-related dry eye using LipiFlow have been reported [15,52]. However, no previous findings have been reported regarding the improvement in postoperative refractive accuracy with preoperative MGD-related dry eye. Therefore, this is the first study to demonstrate that preoperative treatment for MGD-related dry eye considerably improves tear film stability and ocular surface conditions, leading to improved postoperative P-SE accuracy (i.e., refractive accuracy). In addition, no previous studies have reported the effects of preoperative IPL-MGX treatment on preoperative corneal curvature measurements. Therefore, this is the first study to show that preoperative treatment of MGD-related dry eye using IPL-MGX can increase the accuracy of preoperative corneal curvature measurements.
Given the fact that blurred vision is the most common cause of postoperative dissatisfaction (68%) and that postoperative refractive error is the main factor leading to blurred vision [3,4,5], preoperative treatment of MGD-related dry eye using IPL-MGX can be one of the standard preoperative procedures to raise postoperative patient satisfaction.
The combined application of IPL-MGX has been reported to be more effective than the use of either IPL or MGX alone [26,27]. Therefore, in the present study, the IPL-MGX combination therapy was administered. However, the exact mechanisms underlying the effectiveness of IPL therapy remain unclear. Nevertheless, the results are promising. Accordingly, several previous studies have speculated the following possible mechanisms [63,64,65]. The target tissue absorbs IPL flash energy, leading to a localized temperature increase. As the localized temperature increases, lipids are liquefied, leading to improved secretion and excretion. However, the localized temperature increase is not sufficient to liquify other substances such as keratin, which blocks the meibomian gland. Therefore, physical removal using MGX is required. For this reason, IPL and MGX complement each other. Additionally, the absorption of light energy by blood cells can result in the disruption of telangiectatic vessels along the lid margin. Blocking dilated capillaries and decreasing the production of inflammatory mediators can be detrimental to natural inflammatory processes in acinar cells. These processes are responsible for reducing edema. Furthermore, the bacterial load can diminish, and the meibomian gland structure can improve [63,64,65].
This study has several limitations. All participants were Japanese and aged between 59 and 85 years, which may restrict the generalizability of the results to other ethnic groups and age ranges. Moreover, the results may have been influenced by different medical staff and facilities. The Japanese MGD diagnostic criteria were used in the present study because they were designed such that MGD could be easily diagnosed without special equipment or knowledge, even by non-specialists [27]. The Japanese MGD diagnostic criteria did not include functional assessment, meiboscore, or morphological evaluation; therefore, these variables were not assessed in this study. Future studies may benefit from analyzing the relationship between postoperative visual outcomes and these assessments. The Japanese version of the dry eye criteria was used to diagnose dry eye, which is different from the Dry Eye Workshop version of the dry eye criteria [66]. This is mainly because, in comparison with other types of dry eye, the short tear break-up time (TBUT) subtype of dry eye is more prevalent in Asian populations [67,68]. This motivated the Asia Dry Eye Society to create new dry eye diagnostic criteria for Asian populations [69]. Ocular surface damage does not always accurately correlate with the extent of dry eye symptoms in short TBUT-type dry eye [70].
Therefore, additional research using other diagnostic criteria for dry eye is needed to evaluate whether these other criteria affect the findings.
In the current study, the same can be said regarding the assessment of C-SPK, which was conducted using a four-point grading scale established by the National Eye Institute/Industry Workshop. Other assessment methods for C-SPK, such as the Oxford Scheme [63], could also affect the findings. Moreover, the efficacy of alternative physical treatments, including IPL alone, MGX alone, and LipiFlow, for preoperative MGD-related dry eye treatment has been reported [45,46]. However, their efficacy on postoperative visual outcomes has not yet been analyzed. Therefore, a comparison of the efficacy of alternative physical treatment methods for postoperative visual outcomes would be interesting.
Finally, preoperative dry eye treatment using LipiFlow thermal pulsation has been shown to effectively alleviate tear film instability and ocular surface damage, not only in MGD-related dry eye cases but also in dry eye patients without baseline MGD [45]. These results indicate that IPL-MGX may also improve visual function in dry eyes without baseline MGD, which can serve as the basis for further research.

5. Conclusions

The present study illustrates that preoperative MGD-related dry eye treatment with IPL-MGX can be effective in improving tear film stability and ocular surface conditions, as demonstrated by the extension of TBUT and the decrease in HOAs and C-SPK scores, resulting in an improvement in preoperative corneal curvature measurement accuracy. These effects can increase postoperative refractive accuracy. The results of the present study suggest that other types of modern physical MGD-related dry eye treatments may also increase postoperative refractive accuracy in cataract surgery. Therefore, preoperative MGD-related dry eye treatment presents a promising approach to enhancing postoperative patient satisfaction, warranting further investigation and quantifiable evaluation in future research.

Author Contributions

Conceptualization, T.K., T.T., M.A., Y.M., M.T., K.Y., S.H., A.M. and N.M.; methodology, T.K., T.T. and A.M.; software, T.T.; validation, T.K., T.T., A.M. and N.M.; formal analysis, T.T.; investigation, T.K., T.T., M.A., Y.M. and M.T.; resources, K.Y. and S.H.; data curation, T.T.; writing—original draft preparation, T.K. and T.T.; writing—review and editing, A.M. and N.M.; visualization, T.T.; supervision, N.M.; project administration, T.K., T.T. and A.M. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding. The Rapid Service Fee was funded by the authors.

Institutional Review Board Statement

This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the TSURUMI CHUO EYE CLINIC (protocol code 2023-007 and date of approval 6 January 2023).

Informed Consent Statement

Informed consent was obtained from all patients involved in the study. The informed consent form included a clause that allowed patients to withdraw from the study at any time if they chose to undergo dry eye treatment.

Data Availability Statement

The raw data supporting the conclusions of this study will be made available by the authors upon request. The data are not publicly available due to ethical restrictions.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
ALAxial length
ACDAnterior chamber depth
C-SPKSuperficial punctate keratopathy in the corneal center
DDiopters
HOAsHigher-order aberrations
IOLIntra-ocular lens
IPLIntense pulsed light
MGDMeibomian gland dysfunction
MGXMeibomian gland expression
OCTOptical coherence tomography
P-SEPredicted postoperative spherical equivalent
PHACOProspective Health Assessment of Cataract Patients’ Ocular Surface
S-SESubjective postoperative spherical equivalent
TBUTTear break-up time

References

  1. Kaymak, H.; Fahle, M.; Ott, G.; Mester, U. Intraindividual comparison of the effect of training on visual performance with ReSTOR and Tecnis diffractive multifocal IOLs. J. Refract. Surg. 2008, 24, 287–293. [Google Scholar] [CrossRef] [PubMed]
  2. Mollazadegan, K.; Lundström, M. A study of the correlation between patient-reported outcomes and clinical outcomes after cataract surgery in ophthalmic clinics. Acta Ophthalmol. 2015, 93, 293–298. [Google Scholar] [CrossRef] [PubMed]
  3. Gibbons, A.; Ali, T.K.; Waren, D.P.; Donaldson, K.E. Causes and correction of dissatisfaction after implantation of presbyopia-correcting intraocular lenses. Clin. Ophthalmol. 2016, 10, 1965–1970. [Google Scholar] [CrossRef] [PubMed]
  4. Woodward, M.A.; Randleman, J.B.; Stulting, R.D. Dissatisfaction after multifocal intraocular lens implantation. J. Cataract Refract. Surg. 2009, 35, 992–997. [Google Scholar] [CrossRef]
  5. de Vries, N.E.; Webers, C.A.B.; Touwslager, W.R.H.; Bauer, N.J.C.; de Brabander, J.; Berendschot, T.T.; Nuijts, R.M.M.A. Dissatisfaction after implantation of multifocal intraocular lenses. J. Cataract Refract. Surg. 2011, 37, 859–865. [Google Scholar] [CrossRef]
  6. Sheard, R. Optimising biometry for best outcomes in cataract surgery. Eye 2014, 28, 118–125. [Google Scholar] [CrossRef]
  7. Sahin, A.; Hamrah, P. Clinically relevant biometry. Curr. Opin. Ophthalmol. 2012, 23, 47–53. [Google Scholar] [CrossRef]
  8. Dong, J.; Zhang, Y.; Zhang, H.; Jia, Z.; Zhang, S.; Wang, X. Comparison of axial length, anterior chamber depth and intraocular lens power between IOLMaster and ultrasound in normal, long and short eyes. PLoS ONE 2018, 13, e0194273. [Google Scholar] [CrossRef]
  9. Koh, S. Irregular astigmatism and higher-order aberrations in eyes with dry eye disease. Investig. Ophthalmol. Vis. Sci. 2018, 59, DES36–DES40. [Google Scholar] [CrossRef]
  10. Yang, F.; Yang, L.; Ning, X.; Liu, J.; Wang, J. Effect of dry eye on the reliability of keratometry for cataract surgery planning. J. Fr. Ophtalmol. 2024, 47, 103999. [Google Scholar] [CrossRef]
  11. Ahn, S.; Eom, Y.; Song, J.S.; Kim, D.H. Short-term variability in ocular biometry and the impact of preoperative dry eye. Sci. Rep. 2024, 14, 26762. [Google Scholar] [CrossRef] [PubMed]
  12. Teshigawara, T.; Meguro, A.; Mizuki, N. Effects of rebamipide on differences in power and axis of corneal astigmatism between two intra-patient keratometric measurements in dry eyes. Ophthalmol. Ther. 2021, 10, 891–904. [Google Scholar] [CrossRef] [PubMed]
  13. Teshigawara, T.; Akaishi, M.; Mizuki, Y.; Takeuchi, M.; Hata, S.; Meguro, A.; Mizuki, N. Effect of long-acting diquafosol sodium on astigmatism measurement repeatability in preoperative cataract cases with dry eyes: A multicenter prospective study. Ophthalmol. Ther. 2024, 13, 1743–1755. [Google Scholar] [CrossRef]
  14. Hiraoka, T.; Asano, H.; Ogami, T.; Nakano, S.; Okamoto, Y.; Yamada, Y.; Oshika, T. Influence of dry eye disease on the measurement repeatability of corneal curvature radius and axial length in patients with cataract. J. Clin. Med. 2022, 11, 710. [Google Scholar] [CrossRef]
  15. Matossian, C. Impact of thermal pulsation treatment on astigmatism management and outcomes in Meibomian gland dysfunction patients undergoing cataract surgery. Clin. Ophthalmol. 2020, 14, 2283–2289. [Google Scholar] [CrossRef]
  16. Epitropoulos, A.T.; Matossian, C.; Berdy, G.J.; Malhotra, R.P.; Potvin, R. Effect of tear osmolarity on repeatability of keratometry for cataract surgery planning. J. Cataract Refract. Surg. 2015, 41, 1672–1677. [Google Scholar] [CrossRef]
  17. Jo, D.H.; Oh, J.Y.; Kim, M.K.; Lee, J.H.; Wee, W.R. Corneal power estimation using orbscan II videokeratography in eyes with previous corneal refractive surgeries. J. Korean Ophthalmol. Soc. 2009, 50, 1730–1734. [Google Scholar] [CrossRef]
  18. Trattler, W.B.; Majmudar, P.A.; Donnenfeld, E.D.; McDonald, M.B.; Stonecipher, K.G.; Goldberg, D.F. The prospective health assessment of cataract patients’ ocular surface (PHACO) study: The effect of dry eye. Clin. Ophthalmol. 2017, 11, 1423–1430. [Google Scholar] [CrossRef]
  19. Lemp, M.A.; Crews, L.A.; Bron, A.J.; Foulks, G.N.; Sullivan, B.D. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: A retrospective study. Cornea 2012, 31, 472–478. [Google Scholar] [CrossRef]
  20. Amano, S.; Arita, R.; Kinoshita, S.; Yokoi, N.; Sotozono, C.; Komuro, A.; Suzuki, T.; Shimazaki, J.; Den, S.; Maeda, N.; et al. Definition and diagnostic criteria for Meibomian gland dysfunction. Atarashii Ganka (J. Eye) 2010, 27, 627–631. (In Japanese) [Google Scholar]
  21. Cochener, B.; Cassan, A.; Omiel, L. Prevalence of Meibomian gland dysfunction at the time of cataract surgery. J. Cataract. Refract. Surg. 2018, 44, 144–148. [Google Scholar] [CrossRef] [PubMed]
  22. Papageorgiou, P.; Clayton, W.; Norwood, S.; Chopra, S.; Rustin, M. Treatment of rosacea with intense pulsed light: Significant improvement and long-lasting results. Br. J. Dermatol. 2008, 159, 628–632. [Google Scholar] [CrossRef] [PubMed]
  23. Toyos, R.; McGill, W.; Briscoe, D. Intense pulsed light treatment for dry eye disease due to Meibomian gland dysfunction; a 3-year retrospective study. Photomed. Laser Surg. 2015, 33, 41–46. [Google Scholar] [CrossRef]
  24. Miao, S.; Yan, R.; Jia, Y.; Pan, Z. Effect of intense pulsed light therapy in dry eye disease caused by Meibomian gland dysfunction: A systematic review and meta-analysis. Eye Contact Lens 2022, 48, 424–429. [Google Scholar] [CrossRef]
  25. Vergés, C.; Salgado-Borges, J.; Ribot, F.M. Prospective evaluation of a new intense pulsed light, thermaeye plus, in the treatment of dry eye disease due to Meibomian gland dysfunction. J. Optom. 2021, 14, 103–113. [Google Scholar] [CrossRef]
  26. Liu, C.; Zhou, Q.; Gao, Z.Q. Efficacy of intense pulsed light and Meibomian gland expression treatments in Meibomian gland dysfunction: A meta-analysis of randomized controlled trials. Medicine 2022, 101, e32292. [Google Scholar] [CrossRef]
  27. Leng, X.; Shi, M.; Liu, X.; Cui, J.; Sun, H.; Lu, X. Intense pulsed light for Meibomian gland dysfunction: A systematic review and meta-analysis. Graefes Arch. Clin. Exp. Ophthalmol. 2021, 259, 1–10. [Google Scholar] [CrossRef]
  28. Cuschieri, S. The STROBE guidelines. Saudi J. Anaesth. 2019, 13 (Suppl. S1), S31–S34. [Google Scholar] [CrossRef]
  29. Shimazaki, J. Concept of new definition and diagnostic criteria of dry eye disease in 2016. Atarashii Ganka (J. Eye) 2018, 35, 853–857. (In Japanese) [Google Scholar]
  30. Midorikawa-Inomata, A.; Inomata, T.; Nojiri, S.; Nakamura, M.; Iwagami, M.; Fujimoto, K.; Okumura, Y.; Iwata, N.; Eguchi, A.; Hasegawa, H.; et al. Reliability and validity of the Japanese version of the ocular surface disease index for dry eye disease. BMJ Open 2019, 9, e033940. [Google Scholar] [CrossRef]
  31. Teshigawara, T.; Akaishi, M.; Mizuki, Y.; Takeuchi, M.; Yabuki, K.; Hata, S.; Meguro, A.; Mizuki, N. Dry Eye Treatment with Intense Pulsed Light for Improving Visual Outcomes After Cataract Surgery with Diffractive Trifocal Intraocular Lens Implantation. J. Clin. Med. 2024, 13, 6973. [Google Scholar] [CrossRef] [PubMed]
  32. Goto, T.; Zheng, X.; Okamoto, S.; Ohashi, Y. Tear film stability analysis system: Introducing a new application for videokeratography. Cornea 2004, 23, S65–S70. [Google Scholar] [CrossRef] [PubMed]
  33. Smith, J.; Nichols, K.K.; Baldwin, E.K. Current patterns in the use of diagnostic tests in dry eye evaluation. Cornea 2008, 27, 656–662. [Google Scholar] [CrossRef]
  34. Su, T.-Y.; Ting, P.-J.; Chang, S.-W.; Chen, D.-Y. Superficial punctate keratitis grading for dry eye screening using deep convolutional neural networks. IEEE Sens. J. 2020, 20, 1672–1678. [Google Scholar] [CrossRef]
  35. Ichihashi, Y.; Ide, T.; Kaido, M.; Ishida, R.; Hatou, S.; Tsubota, K. Short break-up time type dry eye has potential ocular surface abnormalities. Taiwan J. Ophthalmol. 2015, 5, 68–71. [Google Scholar] [CrossRef]
  36. Kusada, N.; Yokoi, N.; Sotozono, C. Association between corneal higher-order aberrations evaluated with a Videokeratographer and corneal surface abnormalities in dry eye. Diagnostics 2023, 13, 3319. [Google Scholar] [CrossRef]
  37. Koh, S.; Maeda, N.; Hirohara, Y.; Mihashi, T.; Bessho, K.; Hori, Y.; Inoue, T.; Watanabe, H.; Fujikado, T.; Tano, Y. Serial measurements of higher-order aberrations after blinking in patients with dry eye. Investig. Ophthalmol. Vis. Sci. 2008, 49, 133–138. [Google Scholar] [CrossRef]
  38. Gupta, A.; Singh, P. Intraocular Lens Power Calculation; StatPearls Publishing LLC: Treasure Island, FL, USA, 2025. Available online: https://www.ncbi.nlm.nih.gov/books/NBK589643/ (accessed on 21 November 2024).
  39. Kim, J.W.; Eom, Y.; Yoon, E.G.; Choi, Y.; Song, J.S.; Jeong, J.W.; Park, S.K.; Kim, H.M. Algorithmic intraocular lens power calculation formula selection by keratometry, anterior chamber depth and axial length. Acta Ophthalmol. 2022, 100, e701–e709. [Google Scholar] [CrossRef]
  40. Tsubota, K. Short tear film breakup time-type dry eye. Investig. Ophthalmol. Vis. Sci. 2018, 59, DES64–DES70. [Google Scholar] [CrossRef]
  41. Lemp, M.A. Report of the National Eye Institute/industry workshop on clinical trials in dry eyes. CLAO J. 1995, 21, 221–232. [Google Scholar]
  42. Denoyer, A.; Rabut, G.; Baudouin, C. Tear film aberration dynamics and vision-related quality of life in patients with dry eye disease. Ophthalmology 2012, 119, 1811–1818. [Google Scholar] [CrossRef] [PubMed]
  43. Barrett, G.D. An improved universal theoretical formula for intraocular lens power prediction. J. Cataract Refract. Surg. 1993, 19, 713–720. [Google Scholar] [CrossRef] [PubMed]
  44. Armstrong, R.A. Statistical guidelines for the analysis of data obtained from one or both eyes. Ophthalmic Physiol. Opt. 2013, 33, 7–14. [Google Scholar] [CrossRef]
  45. Huang, J.; Huang, J.; Chen, Y.; Ying, G.S. Evaluation of approaches to analyzing continuous correlated eye data when sample size is small. Ophthalmic. Epidemiol. 2018, 25, 45–54. [Google Scholar] [CrossRef]
  46. Kim, H.Y. Statistical notes for clinical researchers: Chi-squared test and Fisher’s exact test. Restor. Dent. Endod. 2017, 42, 152–155. [Google Scholar] [CrossRef]
  47. Hovanesian, J.; Epitropoulos, A.; Donnenfeld, E.D.; Holladay, J.T. The effect of Lifitegrast on refractive accuracy and symptoms in dry eye patients undergoing cataract surgery. Clin. Ophthalmol. 2020, 14, 2709–2716. [Google Scholar] [CrossRef]
  48. Teshigawara, T.; Meguro, A.; Mizuki, N. The effect of rebamipide on refractive accuracy of cataract surgery in patients with dry eye. Ophthalmol. Ther. 2022, 11, 603–611. [Google Scholar] [CrossRef]
  49. Nichols, K.K.; Foulks, G.N.; Bron, A.J.; Glasgow, B.J.; Dogru, M.; Tsubota, K.; Lemp, M.A.; Sullivan, D.A. The international workshop on meibomian gland dysfunction: Executive summary. Investig. Ophthalmol. Vis. Sci. 2011, 52, 1922–1929. [Google Scholar] [CrossRef]
  50. Foulks, G.N.; Nichols, K.K.; Bron, A.J.; Holland, E.J.; McDonald, M.B.; Nelson, J.D. Improving awareness, identification, and management of Meibomian gland dysfunction. Ophthalmology 2012, 119, S1–S12. [Google Scholar] [CrossRef]
  51. Luchs, J.; Buznego, C.; Trattler, W. Asymptomatic or Minimally Symptomatic Blepharitis in Patients Having Cataract Surgery; American Society of Colon and Rectal Surgeons: San Diego, CA, USA, 2011. [Google Scholar]
  52. Szabelska, P.; Gołębiewska, J.; Różycki, R. Impact of thermal pulsation system therapy on pre-operative intraocular lens calculations before cataract surgery in patients with Meibomian gland disfunction. Medicina 2023, 59, 658. [Google Scholar] [CrossRef]
  53. Gupta, P.K. Cataract Surgery in Patients with Meibomian Gland Dysfunction. Cataract & Refractive Surgery Today. 2015. Available online: https://crstoday.com/articles/2015-mar/cataract-surgery-in-patients-with-meibomian-gland-dysfunction (accessed on 18 January 2025).
  54. Covita, A.; Chen, M.H.; Leahy, C. Correlation between Meibomian gland appearance and tear break up time using a slit scanning ophthalmoscope. Investig. Ophthalmol. Vis. Sci. 2019, 60, 6793. [Google Scholar]
  55. Urashima, H.; Okamoto, T.; Takeji, Y.; Shinohara, H.; Fujisawa, S. Rebamipide increases the amount of mucin-like substances on the conjunctiva and cornea in the N-acetylcysteine-treated in vivo model. Cornea 2004, 23, 613–619. [Google Scholar] [CrossRef] [PubMed]
  56. Rhee, J.; Chan, T.C.Y.; Chow, S.S.W.; Di Zazzo, A.; Inomata, T.; Shih, K.C.; Tong, L. A systematic review on the association between tear film metrics and higher order aberrations in dry eye disease and treatment. Ophthalmol. Ther. 2022, 11, 35–67. [Google Scholar] [CrossRef] [PubMed]
  57. Pflugfelder, S.C. Tear dysfunction and the cornea: LXVIII Edward Jackson Memorial Lecture. Am. J. Ophthalmol. 2011, 152, 900–909.e1. [Google Scholar] [CrossRef]
  58. Roh, H.C.; Chuck, R.S.; Lee, J.K.; Park, C.Y. The effect of corneal irregularity on astigmatism measurement by automated versus ray tracing keratometry. Medicine 2015, 94, e677. [Google Scholar] [CrossRef]
  59. Lane, S.S.; Dubiner, H.B.; Epstein, R.J.; Ernest, P.H.; Greiner, J.V.; Hardten, D.R.; Holland, E.J.; Lemp, M.A.; McDonald, J.E.; Silbert, D.I.; et al. A new system, the LipiFlow, for the treatment of Meibomian gland dysfunction. Cornea 2012, 31, 396–404. [Google Scholar] [CrossRef]
  60. Safir, M.; Hecht, I.; Ahimor, A.; Zmujack-Yehiam, S.; Stein, R.; Bakshi, E.; Einan-Lifshitz, A.; Hartstein, M.E. The effect of thermo-mechanical device (Tixel) treatment on evaporative dry eye disease—A pilot prospective clinical trial. Cont. Lens Anterior Eye 2022, 45, 101741. [Google Scholar] [CrossRef]
  61. Park, J.; Yoo, Y.S.; Shin, K.; Han, G.; Arita, R.; Lim, D.H.; Chung, T.Y. Effects of Lipiflow treatment prior to cataract surgery: A prospective, randomized, controlled study. Am. J. Ophthalmol. 2021, 230, 264–275. [Google Scholar] [CrossRef]
  62. Ge, J.; Liu, N.; Wang, X.; Du, Y.; Wang, C.; Li, Z.; Li, J.; Wang, L. Evaluation of the efficacy of optimal pulsed technology treatment in patients with cataract and Meibomian gland dysfunction in the perioperative period. BMC Ophthalmol. 2020, 20, 111. [Google Scholar] [CrossRef]
  63. Rong, B.; Tu, P.; Tang, Y.; Liu, R.X.; Song, W.J.; Yan, X.M. Evaluation of short-term effect of intense pulsed light combined with Meibomian gland expression in the treatment of Meibomian gland dysfunction. Zhonghua Yan Ke Za Zhi. 2017, 53, 675–681. (In Chinese) [Google Scholar] [CrossRef]
  64. Li, H.; Huang, L.; Fang, X.; Xie, Z.; Xiao, X.; Luo, S.; Lin, Y.; Wu, H. The photothermal effect of intense pulsed light and LipiFlow in eyelid related ocular surface diseases: Meibomian gland dysfunction, demodex and blepharitis. Heliyon 2024, 10, e33852. [Google Scholar] [CrossRef] [PubMed]
  65. Vegunta, S.; Patel, D.; Shen, J.F. Combination therapy of intense pulsed light therapy and Meibomian gland expression (IPL/MGX) can improve dry eye symptoms and Meibomian gland function in patients with refractory dry eye: A retrospective analysis. Cornea 2016, 35, 318–322. [Google Scholar] [CrossRef] [PubMed]
  66. DEWS Definition and Classification Subcommittee. The definition and classification of dry eye disease: Report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop. Ocul. Surf. 2007, 5, 75–92. [Google Scholar] [CrossRef] [PubMed]
  67. Kawashima, M.; Yamada, M.; Suwaki, K.; Shigeyasu, C.; Uchino, M.; Hiratsuka, Y.; Yokoi, N.; Tsubota, K.; DECS-J Study Group. A clinic-based survey of clinical characteristics and practice pattern of dry eye in Japan. Adv. Ther. 2017, 34, 732–743. [Google Scholar] [CrossRef]
  68. Uchino, M.; Yokoi, N.; Uchino, Y.; Dogru, M.; Kawashima, M.; Komuro, A.; Sonomura, Y.; Kato, H.; Kinoshita, S.; Schaumberg, D.A.; et al. Prevalence of dry eye disease and its risk factors in visual display terminal users: The Osaka study. Am. J. Ophthalmol. 2013, 156, 759–766. [Google Scholar] [CrossRef]
  69. Tsubota, K.; Yokoi, N.; Shimazaki, J.; Watanabe, H.; Dogru, M.; Yamada, M.; Kinoshita, S.; Kim, H.M.; Tchah, H.W.; Hyon, J.Y.; et al. New perspectives on dry eye definition and diagnosis: A consensus report by the Asia Dry Eye Society. Ocul. Surf. 2017, 15, 65–76. [Google Scholar] [CrossRef]
  70. Kaido, M.; Kawashima, M.; Ishida, R.; Tsubota, K. Severe symptoms of short tear break-up time dry eye are associated with accommodative microfluctuations. Clin. Ophthalmol. 2017, 11, 861–869. [Google Scholar] [CrossRef]
Jcm 14 02805 g001
Figure 1. IPL protocol (Step 1): A double-pass technique involving 12 pulses was applied to the infraorbital and lower eyelid region using a 15 × 35 mm guide light. IPL refers to intense pulsed light. The diagram illustrates the procedure with eye patches; it is intended for illustrative purposes only and does not depict an actual patient [31].
Figure 1. IPL protocol (Step 1): A double-pass technique involving 12 pulses was applied to the infraorbital and lower eyelid region using a 15 × 35 mm guide light. IPL refers to intense pulsed light. The diagram illustrates the procedure with eye patches; it is intended for illustrative purposes only and does not depict an actual patient [31].
Jcm 14 02805 g001
Jcm 14 02805 g002
Figure 2. IPL protocol (Step 2): A single-pass technique consisting of three pulses was administered to the upper (a) and lower (b) eyelids using an 8 × 15 mm guide light. IPL stands for intense pulsed light. The diagram illustrates the procedure with eye patches for demonstration purposes only and does not represent an actual patient [31].
Figure 2. IPL protocol (Step 2): A single-pass technique consisting of three pulses was administered to the upper (a) and lower (b) eyelids using an 8 × 15 mm guide light. IPL stands for intense pulsed light. The diagram illustrates the procedure with eye patches for demonstration purposes only and does not represent an actual patient [31].
Jcm 14 02805 g002
Jcm 14 02805 g003
Figure 3. Accuracy of the predicted postoperative spherical equivalent (P-SE) evaluated using data obtained before and after IPL-MGX treatment. X-axis: the absolute difference between subjective postoperative spherical equivalent and predicted postoperative spherical equivalent. D, diopter. Y-axis: proportion of patients.
Figure 3. Accuracy of the predicted postoperative spherical equivalent (P-SE) evaluated using data obtained before and after IPL-MGX treatment. X-axis: the absolute difference between subjective postoperative spherical equivalent and predicted postoperative spherical equivalent. D, diopter. Y-axis: proportion of patients.
Jcm 14 02805 g003
Table 1. Differences in AL, ACD, and mean-K.
Table 1. Differences in AL, ACD, and mean-K.
Pre-IPL-MGX TreatmentPost-IPL-MGX Treatmentp-Value
MeanSDMedianMeanSDMedian
AL (mm)23.861.4923.3823.841.4623.380.85
ACD (mm)2.980.3632.990.363.020.56
Mean-K (D)43.361.7243.4243.181.8143.25<0.01
AL, axial length; ACD, anterior chamber depth; IPL-MGX, combination treatment of intense pulsed light and meibomian gland expression; SD, standard deviation; Mean-K, corneal curvature.
Table 2. Differences in T-BUT, C-SPK, and HOAs between pre-and post-IPL-MGX treatment.
Table 2. Differences in T-BUT, C-SPK, and HOAs between pre-and post-IPL-MGX treatment.
Pre-IPL-MGX TreatmentPost-IPL-MGX Treatmentp-Value
MeanSDMedianMeanSDMedian
TBUT (s)2.641.053.004.181.164.00<0.01
C-SPK1.000.891.000.500.570.00<0.01
HOAs (µm)0.320.040.330.270.030.27<0.01
TBUT, tear break-up time; C-SPK, superficial punctate keratopathy in the center part of cornea; HOAs, higher-order aberrations; IPL-MGX, combination treatment of intense pulsed light and meibomian gland expression; SD, standard deviation.
Table 3. Accuracy of P-SE.
Table 3. Accuracy of P-SE.
Pre-IPL-MGX TreatmentPost-IPL-MGX Treatmentp-Value
MeanSDMedianMeanSDMedian
Accuracy of P-SE (D)0.470.20.450.280.150.24<0.01
P-SE, predicted postoperative spherical equivalent; S-SE, subjective postoperative spherical equivalent; accuracy of P-SE (D), the absolute difference between P-SE and S-SE; IPL-MGX, combination treatment of intense pulsed light and meibomian gland expression; SD, standard deviation.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Kawagoe, T.; Mizuki, Y.; Akaishi, M.; Takeuchi, M.; Yabuki, K.; Hata, S.; Meguro, A.; Mizuki, N.; Teshigawara, T. 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. J. Clin. Med. 2025, 14, 2805. https://doi.org/10.3390/jcm14082805

AMA Style

Kawagoe T, Mizuki Y, Akaishi M, Takeuchi M, Yabuki K, Hata S, Meguro A, Mizuki N, Teshigawara T. 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. Journal of Clinical Medicine. 2025; 14(8):2805. https://doi.org/10.3390/jcm14082805

Chicago/Turabian Style

Kawagoe, Tatsukata, Yuki Mizuki, Miki Akaishi, Masaki Takeuchi, Kazuro Yabuki, Seiichiro Hata, Akira Meguro, Nobuhisa Mizuki, and Takeshi Teshigawara. 2025. "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" Journal of Clinical Medicine 14, no. 8: 2805. https://doi.org/10.3390/jcm14082805

APA Style

Kawagoe, T., Mizuki, Y., Akaishi, M., Takeuchi, M., Yabuki, K., Hata, S., Meguro, A., Mizuki, N., & Teshigawara, T. (2025). 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. Journal of Clinical Medicine, 14(8), 2805. https://doi.org/10.3390/jcm14082805

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop