Background Despite increasing evidence shows that optimising ocular surface before cataract surgery is fundamental in patients with pre-existing dry eye disease (DED) to achieve the desired postoperative outcomes, the prophylactic treatment of healthy patients undergoing surgery aiming at preventing iatrogenic DED is worth investigating. Methods This was a prospective, interventional, randomised, controlled, double-masked clinical trial. Patients were randomly assigned 1:1 to receive either low-level light therapy (LLLT) or sham treatment (LLLT with a power output <30%). Patients underwent two treatment sessions: 7±2 days before cataract surgery (T0) and 7±2 days after (T1). Outcome measures evaluated 30±4 days after surgery (T2) included Ocular Surface Disease Index (OSDI) questionnaire, non-invasive break-up time (NIBUT), tear meniscus height, meibomian gland loss (MGL) and redness score. Results Out of 153 patients randomised to receive LLLT (n=73) or sham treatment (n=80), 131 (70 men, 61 women, mean age 73.53±7.29 years) completed regularly the study. Patients treated with LLLT had significantly lower OSDI scores compared with controls at T1 and T2 (respectively, 7.2±8.8 vs 14.8±13.0 and 9.0±9.0 vs 18.2±17.9; both p<0.001), higher NIBUT values at T2 (12.5±6.6 vs 9.0±7.8; p=0.007) and lower MGL Meiboscore values at T1 (1.59±0.70 vs 1.26±0.69; p=0.008). Unlike controls, patients treated with LLLT had significantly lower OSDI scores and higher NIBUT values at T2 compared with T0 (respectively, 9.0±9.0 vs 21.2±16.1; p<0.001 and 12.5±6.6 vs 9.7±7.2; p=0.007). Conclusion Two sessions of LLLT performed before and after cataract surgery were effective in ameliorating tear film stability and ocular discomfort symptoms. Trial registration number NCT05754437.

Purpose: To evaluate prevalence and characteristics of pathological ocular surface findings in healthy patients undergoing cataract surgery using a noninvasive ocular surface workup and a validated questionnaire.Design: Prospective single-centre study (sub-analysis clinical trial no. NCT05754437).Methods: Healthy patients undergoing senile cataract surgery were screened preoperatively by Oculus Keratograph (K5 M; Oculus GmbH, Wetzlar, Germany) for the evaluation of tear meniscus height (TMH), non-invasive keratograph break-up time (NIKBUT), and meibomian gland dropout. Ocular discomfort symptoms were scored by ocular surface disease index (OSDI) questionnaire.Results: 120 eyes of 120 patients (62 females, 58 males; mean age 73.85 years, range 47–91 years) were included. All patients had at least 1 abnormal finding, while 19 (15.8%; 95% CI [0.09–0.22]) had alterations of all parameters. In detail, 39 patients (32.5%; 95% CI [0.24–0.41]) had pathological TMH (mean 0,15 mm [0.03 SD]), 102 (85%; 95% CI [0.79–0.91]) had pathological NIKBUT (mean 3.64 s [2.63 SD]), 117 (97.5%; 95% CI [0.95–1]) had some degree of gland dropout (mean 1.62 [0.70 SD]), 78 patients (65%; 95% CI [0.56–0.74]) had pathological OSDI scores (mean 28.63 [15.08 SD]). Using TFOS DEWS II criteria, 66 patients (55%; 95% CI [0.42–0.60]) resulted affected by dry eye.Conclusions: This quick noninvasive screening documented the high prevalence of pathological ocular surface parameters in patients without risk factors or previous diagnosis of dry eye who are scheduled for cataract surgery.

Purpose: To assess the feasibility and the diagnostic accuracy of the new tool, DEvice© (AI, Rome, Italy), for screening patients with dry eye disease (DED). Methods: This study was performed at the University Magna Græcia of Catanzaro. Enrolled patients were classified as affected by DED (group 1) or not (group 2) using an already validated tool (Keratograph 5M, Oculus, Germany), evaluating the noninvasive keratograph breakup time (NIKBUT), tear meniscus height (TMH), meibomian gland loss (MGL), and bulbar redness. All the patients were then examined by means of DEvice©, which allowed the measurement of the relative humidity (RH) and temperature of the ocular surface. Symptoms were scored using the Ocular Surface Disease Index (OSDI) questionnaire. Results: Overall, 40 patients (17 males and 23 females, mean age 38.0 ± 17.1 years) were included: of these, 20 belonged to group 1 and the remaining 20 to group 2. Using Keratograph 5M, significant differences between groups 1 and 2 were detected for NIKBUT-first (respectively, 4.97 ± 1.85 vs. 13.95 ± 4.8 s; p < 0.0001) and for NIKBUT-average (10.55 ± 4.39 vs. 15.96 ± 4.08 s; p = 0.0003). No statistically significant changes were detected for TMH (p = 0.565), MGL (p = 0.051), and bulbar redness (p = 0.687). Using Device©, a statistically significant higher value of RH was found in group 1 compared to group 2 (respectively, 85.93 ± 10.63 vs. 73.05 ± 12.84%; p = 0.0049). A statistically significant correlation was found between RH and OSDI (r = 0.406; p = 0.009). The value RH showed a discriminating power to detect DED with an AUC = 0.782 (standard error 0.07264; 95% CI 0.6401–0.9249; p = 0.0022). Conclusions: The DEvice© can effectively discriminate DED patients from healthy subjects. The parameter RH showed good sensitivity, making this tool ideal for a fast and noninvasive DED screening.

(1) Background: Dry eye disease (DED) is a multifactorial ocular surface disease characterized by an imbalance in ocular surface homeostasis, and tear substitutes constitute the first line of treatment. The present study aimed to evaluate the changes in the signs and symptoms of patients with DED treated with a novel tear substitute containing the GlicoPro^® complex. (2) Methods: Patients with DED not successfully responding to other tear substitutes were enrolled and treated with a novel ophthalmic solution (two drops four times daily). Patients were examined before starting the study treatment (T0) and after 30 (T1) and 60 (T2) days of treatment by means of Keratograph for the evaluation of the following: (i) tear meniscus height (TMH); (ii) noninvasive Keratograph break-up time (NIKBUT); (iii) bulbar redness; and (iv) infrared meibography. The SANDE questionnaire was administered to assess ocular discomfort symptoms. Analysis of the tear content of proenkephalin and Met/Leu-enkephalin was also performed. (3) Results: At T2, a significant improvement in NIKBUT first, average, and class, TMH, and SANDE score was found. The tear content of proenkephalins was significantly higher at T1, whereas processed active Met/Leu-enkephalins increased at both T1 and T2. (4) Conclusions: Our novel tear substitute based on GlicoPro^® resulted in a significant improvement in ocular discomfort symptoms, tear volume, and stability in the patients treated. The increase in active peptides processed in tears may represent the pathophysiological substrate underlying this finding.

Aims To describe a simple surgical technique consisting of opening the vertical graft-host junction (GHJ) to manage high astigmatism following deep anterior lamellar keratoplasty (DALK) and to report postoperative visual and topographic outcomes. Methods This is a retrospective interventional case series. Patients affected by high astigmatism after DALK underwent progressive opening of the previous GHJ at the steep meridians, established with preoperative topography and intraoperative keratoscopic guidance. Evaluations were carried out with best corrected visual acuity (BCVA), refractive astigmatism (RA) and keratometric astigmatism (KA) measured with Casia (Tomey, Japan). Visits were conducted preoperatively (T0), 1 week (T1), 6 months (T2) and 1 year after surgery (T3). The Alpins Method was used to evaluate vectorial changes in KA between T0 and T3. Results Fifteen patients were included in the analysis. BCVA (median (IQR)) increased significantly from 0.70 (0.5–1.1) at T0 to 0.20 (0.1–0.3) logMAR at T3 (p=0.001). RA (mean±SD) at T3 was 2.28±1.59 dioptres (D). KA (mean±SD) varied significantly from 8.04±2.14 D at T0 versus 2.93±1.94 D at T1 versus 3.15±1.79 D at T2, versus 3.23±1.63 D at T3 (p<0.0001). Vectorial analysis showed that target induced astigmatism (mean±SD) was 8.04±2.14 D, while surgically induced astigmatism (mean±SD) was 7.89±4.27 D. Correction index (mean±SD) was 0.92±0.33. Conclusions High astigmatism after DALK can be safely and effectively managed by opening the GHJ down to the cleavage plane achieved with the previous surgery, providing low KA and RA, with an overall low tendency to overcorrection.

Introduction: Inferior retinal detachment (I-RD) complicated by proliferative vitreoretinopathy (PVR) is challenging to treat and prone to recurrence (retinal detachment recurrence [RDR]). Heavy silicone oil (HSO) tamponades such as Densiron 68 have improved inferior tamponade and are widely used in this setting. It was evaluated whether prolonged Densiron 68 tamponade (>3 months) protects against RDR after oil removal, overall and in patients with previous failed retinal detachment (RD) surgery. Methods: We retrospectively reviewed 112 consecutive eyes with rhegmatogenous I-RD and grade-C PVR treated with pars plana vitrectomy and Densiron 68. Mean follow-up after oil removal was ∼12 months. Multivariate logistic regression was performed including laterality, sex, age, tamponade duration, previous failed RD surgery, previous silicone oil tamponade, lens status, and 360° laser retinopexy. Patients were then stratified by history of failed RD surgery (History−/History+) and by tamponade duration (short ≤3 months vs. long >3 months). Results: After Densiron 68 removal, 24 eyes (29.3%) developed RDR. Anatomical success was 63.0% with one operation and no tamponade, 82.6% after additional procedures, and 92.4% including eyes stable with silicone oil in situ. In multivariate analysis, no covariate was significantly associated with RDR; prolonged tamponade was not protective overall (OR = 1.02; p = 0.867). Previous failed RD surgery showed the strongest association with higher recurrence risk (OR = 1.15; p = 0.070). Stratified analysis revealed that eyes with previous failed RD surgery had significantly higher odds of RDR (OR = 4.44; p = 0.0028). Within this group, prolonged tamponade was associated with lower recurrence compared with short tamponade (OR = 3.96; p = 0.025). In eyes without prior surgery, tamponade duration had no effect (p = 0.979). Most recurrences (84.85%) occurred within 3 months from surgery. Conclusion: Prolonged Densiron 68 tamponade did not reduce RDR risk in the overall cohort but conferred protection in eyes with previous failed RD surgery. Extending tamponade may therefore be justified in specific high-risk group of patients, while routine prolongation in lower-risk cases appears unnecessary. Prospective validation is needed to refine timing of HSO removal and optimize outcomes.