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Meibomian Gland Dysfunction in a Cataract Surgery Patient: A Chronological Timeline

A 61-year-old woman, who had previously been a practicing optometrist, presented for cataract surgery and expressed interest in a TECNIS Symfony IOL®. Casey Claypool, OD, at Empire Eye Physicians examined her one month prior and noted an overall 2+ meibomian gland dysfunction (MGD) characterized by 1+ telangiectasis of the lid margins, poor expressibility of the meibum, and 2+ turbidity of the meibum. An incomplete blink and an average lipid layer thickness of 100 nm was noted on LipiView® II reports.*

Dynamic Meibomian Imaging demonstrated minimal gland loss, with mild truncation, but overall decent meibomian gland architecture. At this time, she reported minor dry eye symptoms, including visual fluctuations and a significant increase in symptoms in the morning that persisted until she instilled artificial tears. Treatment with Vectored Thermal Pulsation therapy was performed.

After the LipiFlow® treatment, the patient noted a reduced reliance on artificial tears, more consistent vision, and that her morning dry eye symptoms were much improved. Seven weeks later, she presented to me for cataract surgery and pre-operative testing showed a 1.00 D shift in IOL recommendation compared with biometry measurements taken 3 months prior. Ultimately, a +22.50 D TECNIS Symfony® was selected. At one day postoperative, the patient's VA was 20/20 at both distance and near and 20/16 at intermediate range.

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