American Journal of Ophthalmology

The Effect of a Ptosis Procedure Compared to an Upper Blepharoplasty on Dry Eye Syndrome
Ofira Zloto; Adham Matani; Daphna Prat; Ari Leshno; GuyBen Simon
Purpose
To examine the effect of combined blepharoplasty and Müller muscle-conjunctival resection (MMCR) compared to an upper blepharoplasty on dry eye syndrome.
Design
Prospective, comparative clinical study.
Methods
This is prospective, comparative case series. Two groups of patients participated in this study: the blepharoplasty group included adult patients with dermatochalasis and the ptosis group consisted of adult patients with dermatochalasis and ptosis that showed significant improvement after phenylephrine 10% instillation. The following parameters were compared for all patients before the procedure (baseline) and on postoperative day 90: MRD1, Ocular-Surface-Disease-Index (OSDI), Schirmer test 2, tear break-up time (TBUT), fluorescein staining, Lissamine-green staining (LG).
Results
Fifty-four patients participated in this study (blepharoplasty group: 23 patients, ptosis group 31 patients). There were significant increases in the postoperative LG scores and in fluorescein staining post ptosis surgery compared with the preoperative values (paired t test, P = .05 and P = .02, respectively). The postoperative OSDI score was significantly higher post ptosis surgery compared with the preoperative score (25.38 vs 17.24, respectively, paired t test, P < .01). There were no significant differences, in the blepharoplasty group, between the postoperative and preoperative objective and subjective dry eye tests.
Conclusions
MMCR surgery causes an increase in the subjective feeling of dry eye as well as an increase of signs of dry eye. This increase was not noticed after blepharoplasty surgery. Physicians should be aware of the risk of dry eye after ptosis surgery and discuss dry eye as a complication of MMCR surgery with their patients before surgery. Those patients should be examined carefully and treated for dry eye during follow-up.

Accuracy of Intraocular Lens Formulas in Eyes With Keratoconus
Kendrick M; Wang; Albert S; Jun; John G; Ladas; Aazim A; Siddiqui; Fasika Woreta; Divya Srikumarana
Purpose
To evaluate the refractive accuracy of current intraocular lens (IOL) formulas in eyes with keratoconus.
Design
Retrospective case series.
Methods
Preoperative optical biometry, Pentacam topography, and postoperative outcomes were collected from eyes with keratoconus that had uncomplicated cataract surgery between 2014 and 2018 at a single institution. Exclusion criteria include postoperative best-corrected spectacle visual acuity worse than 20/40, multifocal lens, prior ophthalmic surgeries, and prior ocular trauma. The Hoffer Q, SRK/T, Holladay I, Holladay II, Haigis, and Barrett Universal II formulas were analyzed in each eye stratified by keratoconus severity.
Results
A total of 73 eyes were included. All formulas had a positive mean predicted error ranging from 0.10 to 4.38 diopters (D). The Barrett Universal II formula had the lowest median absolute error for stage I (n = 46, 0.445 D) and II (n = 22, 0.445 D) eyes, and the highest percentage of eyes with predicted error within ±۰.۵۰ D for both stage I (52%) and II (50%) eyes. In stage III eyes (n = 5), the Haigis formula had the lowest median predicated error (1.90 D) and the highest percentage of eyes with predicted error within ±۰.۵۰ D (40%). Corneal power measured by optical biometers was higher than measurements by Pentacam keratometry.
Conclusions
All formulas tend to have a hyperopic surprise. The Barrett Universal II formula was the most accurate for mild to moderate disease. Pentacam keratometry may help avoid hyperopic outcomes.