OBJECTIVE:To predict patient satisfaction 6 months after small-incision lenticule extraction (SMILE) surgery from preoperative clinical data demonstrating the methodological utility of open-source orange data mining software (Orange) feature selection and machine learning (ML) for practice-based evidence. DESIGN:A retrospective study. PARTICIPANTS:Seventy-eight patients who had undergone bilateral uncomplicated SMILE surgery at a private ophthalmology clinic for treatment of their myopic refractive error with complete records available for analysis. METHODS:Open-source data mining software Orange was applied to the data. Ten preoperative features (predictors) were investigated. The target (predicted variable) was patient expectations met or exceeded 6 months postoperatively. To simplify downstream clinical interpretation, continuous metrics were discretized using a median-split protocol. Fast correlation-based filter (FCBF) feature selection and Naïve Bayes supervised ML were applied. Optimistic and realistic ML performance were expressed as the area under the receiver operating characteristic (AUC) and Matthews' correlation coefficient (MCC). A nomogram generated log-odds ratios for estimating how each feature influenced the probability of exceeded expectations. MAIN OUTCOME MEASURES:Primary outcome was ML performance assessed using AUC and MCC. RESULTS:Only 4 clinically relevant features (mean sphere equivalent, sex, quality of vision [QoV] night, corneal staining) were selected using FCBF. Comparable ML performance arose using these 4 features (optimistic: AUC = 0.792, MCC = 0.441; realistic 10-fold cross-validation: AUC = 0.749, MCC = 0.335) or all 10 (optimistic: AUC = 0.778, MCC = 0.447; realistic: AUC = 0.679, MCC = 0.329). Similarity between optimistic and realistic performance indicated sample sufficiency and model stability. The probability of a patient's expectations being exceeded increased by 13.68% for lower magnitude MSE (≥ -3.875 D), 15.15% for males, 10.17% for QoV night scores ≥9, and 8.73% when corneal staining was present, with Orange restricting log-odds measurements to point estimates. CONCLUSIONS:Open-source ML software was applied for preoperative prediction of patient satisfaction following SMILE surgery. By using feature selection to ensure feature independence, ML enables clinicians to identify the most relevant preoperative factors, improving surgical counselling and patient expectation management. Reducing redundant clinical tests could optimize preoperative screening, making no-code visual ML decision support tools valuable and accessible in real-world clinical settings.

Purpose:To outline the early postoperative visual performance and subjective quality of vision (QoV) after implantation of a new fully refractive extended depth of focus intraocular lens (IOL). Patients and Methods:The study enrolled 103 patients undergoing bilateral phacoemulsification with implantation of the Tecnis PureSee IOL (Johnson & Johnson). Refraction, uncorrected (UDVA) and best-corrected (CDVA) distance visual acuities, uncorrected intermediate (UIVA) and near (UNVA) visual acuities, defocus curves, electronic reading desk, QoV questionnaire and a halo and glare simulator were evaluated 3 months postoperatively. Results:Mean binocular UDVA, UIVA and UNVA were -0.06 ± 0.07, 0.05 ± 0.08 and 0.20 ± 0.08 logMAR respectively. At 3 months, 83% were within ± 0.50D and 99% within ± 1.00D of the refractive aim. Minimal dysphotopsias and overall QoV scores of 8.68 ± 1.13 for the day and 8.08 ± 1.58 at night were reported. Of all patients, 98.1% reported better vision than preoperatively and 86.4% would recommend the procedure. Spectacle independence for distance, intermediate, and near was achieved in 100%, 94.2% and 66% of patients respectively. Conclusion:The Tecnis PureSee IOL provided excellent distance and intermediate vision with good functional near vision. Patients reported high postoperative QoV and subjective functional vision, with minimal visual side effects.

Background: To determine whether accounting for posterior corneal surgically induced astigmatism (SIA) would improve toric intraocular lens power calculation prediction error. Methods: A total of 189 eyes of 148 patients undergoing routine cataract surgery were included in the study. Standard and posterior keratometry were measured pre- and postoperatively. Centroid SIA with standard keratometry and posterior keratometry were calculated separately. Prediction errors for postoperative refractive astigmatism at 4 weeks postoperatively were compared for Barrett Toric with predicted posterior corneal astigmatism (PPCA); Barrett Toric with preoperative measured posterior corneal astigmatism (MPCA); Barrett Toric with postoperative MPCA, which accounts for posterior corneal SIA. Results: There was a significant increase in PCA magnitude postoperatively (p < 0.001), although a change of >0.3D occurred in only 3% of eyes. There was a postoperative rotation in the steep meridian of >10 degrees in 32% of eyes. The Barrett Toric formula with PPCA yielded a significantly smaller refractive astigmatism prediction error compared to when a postoperative MPCA value was used (p < 0.01). Postoperative MPCA had a lower proportion of eyes within 0.50, 0.75 and 1.00D of predicted refractive astigmatism than PPCA or preoperative MPCA, although this was not statistically significant. Conclusion: This study demonstrated postoperative changes in posterior corneal astigmatism magnitude and the orientation of the steep meridian. However, accounting for posterior keratometric SIA in the Barrett Toric formula does not improve refractive astigmatism prediction accuracy.

Objectives: Fluorescein break-up time (FBUT) is commonly used to assess tear film stability. However, the instillation of fluorescein destabilises the tear film, impacting validity and clinical applicability, while the subjective nature and variation in volume and concentration reduces repeatability. Non-invasive break-up time (NIBUT) offers an alternative method with less potential bias. Normal tear break-up time is conventionally accepted as 10 seconds (s); however, FBUT is expected to be lower than NIBUT. This study was designed to compare FBUT and NIBUT values in a pre-operative refractive surgery population, where diagnosis of dry eye disease may alter the risk-benefits ratio and contraindicate surgical procedure(s). Improved understanding of the relationship between these two methods will aid appropriate pre-operative patient counselling and consent. Methods: Data from consecutive participants presenting to a private ophthalmology clinic, for initial refractive surgery pre-operative assessment, were analysed. NIBUT and FBUT were performed. Paired and unpaired comparisons were made using the Wilcoxon signed-rank and Mann-Whitney U tests, respectively, and relationships with demographics were explored using Spearman's rank correlation coefficient. Results: Median and interquartile range (IQR) for the first NIBUT was 12.5 s (7.0-18.0 s) and 14.2 s (9.4-18.0 s) for the right and left eyes, respectively. Median and IQR for the average NIBUT was 14.0 s (6.9-18.0 s) and 14.6 s (10.1-18.0 s) for the right and left eyes, respectively. Median and IQR for FBUT was 7 s (5-8 s) and 6 s (5-8 s) for the right and left eyes, respectively. There was a statistically significant difference between NIBUT and FBUT (p < 0.001). Conclusions: The findings suggest that the commonly used diagnostic threshold of 10 s cannot be uniformly applied to both FBUT and NIBUT, as FBUT systematically underestimates tear stability.

This article provides an assessment of the impact of different levels of monovision upon early visual outcomes and quality of vision (QoV) following the bilateral implantation of enhanced monovision intraocular lenses (IOLs). Consecutive patients implanted bilaterally with the Rayone EMV (Rayner) were recruited. The dominant eye was targeted for emmetropia, and myopia was targeted in the nondominant eye. Patients were categorized based upon the postoperative refractive outcome in the nondominant eye as follows: Group A: −0.50 to −1.0 D (n = 40), Group B: <−1.00 = D (n = 46). Uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuity, and QoV were compared 3 months postoperatively. Binocular UIVA was 0.05 ± 0.10 and −0.01 ± 0.11logMAR (p = 0.03) in the two respective groups, and binocular UNVA was 0.23 ± 0.09 and 0.14 ± 0.09logMAR (p < 0.001). Day QoV was 8.77 ± 1.33 and 8.13 ± 1.34 for night QoV in group A, and 8.85 ± 0.99 and 7.85 ± 1.35, respectively, in group B. Group A had a lower spectacle independence rate of 55% compared to 89.1%. This IOL provides a satisfactory range of vision with high QoV satisfaction. A postoperative refractive error of −1.0 D or more in the nondominant eye significantly improves binocular UIVA, UNVA, and spectacle independence, without negatively impacting QoV.

Purpose:The purpose of this study was to investigate the influence of corneal diameter (CD) on corneal biomechanics and biometry parameters to allow more accurate evaluation of refractive surgery patients. Methods:In this cross-sectional study, 203 Chinese participants were categorized into four groups based on CD (group A = CD ≤11.1 mm, group B = CD = 11.2-11.5 mm, group C = CD = 11.6-12 mm, and group D = CD >12.0 mm). Data collected included age, gender, intraocular pressure, spherical equivalent, and parameters from the Pentacam and Corvis ST. Statistical analysis was performed using SPSS software. Results:The study included 203 eyes. For the Pentacam examination, corneal curvature, thinnest pachymetry (TP), back elevations (BEs), corneal elevation difference (front and back), pachymetry progression indices (PPIs), index of surface variance (ISV), keratoconus percentage index (KISA%), and most of the Belin/Ambrósio Enhanced Ectasia Display (BAD) parameters were negatively correlated with CD (linear regression analysis, P < 0.05). The abnormal rate of Pentacam parameters in the CD ≤11.1 mm group was higher than other groups. For Corvis ST, CD was positively correlated with peak distance (PD) and Ambrósio relational thickness to the horizontal profile (Arth), but negatively correlated with tomographic and biomechanical index (TBI) and Corvis biomechanical index (CBI; linear regression analysis, P < 0.05). The CD ≤11.1 mm group demonstrated the highest CBI and TBI values, although these parameters remained within the normal range. Conclusions:Corneal diameter significantly influences Pentacam and Corvis ST parameters, particularly on BE, BAD-D, PPIs, CBI, and TBI. Translational Relevance:Incorporating corneal diameter into preoperative screening may help improve the specificity of keratoconus detection and reduce unnecessary exclusion of eligible refractive surgery candidates with small corneas.

Modern cataract surgery continues to advance, yet intraocular lens (IOL) based surgery in the small adult eye remains challenging. Thorough preoperative assessment and surgical preparation optimise postoperative outcomes in these cases. Advances in IOL power calculation, including artificial intelligence-driven formulas, improve accuracy; however, careful consideration of biometry and IOL power selection is still necessary because inaccuracies can produce significant errors. Limited availability of high-powered IOLs to fully correct high refractive errors may necessitate further intervention. Surgical techniques have evolved to address the unique anatomical challenges of small eyes, improving safety and outcomes. Knowledge of the potential risks inherent in these cases can assist the surgeon in modifying the operative technique accordingly. This review discusses essential preoperative assessments, IOL power selection, surgical techniques, and potential complications, offering guidance for surgeons performing cataract surgery on small adult eyes.

PURPOSE OF REVIEW:Modern presbyopia-correcting intraocular lenses (IOLs) offer a potential solution to address the rising postoperative demand and expectations for spectacle independence following cataract surgery. However, IOL calculation and selection becomes more complex when presented with previous corneal refractive surgery (CRS) or co-existing corneal conditions. This review explores the use of presbyopia-correcting IOLs in eyes with co-existing corneal conditions or surgically altered corneas. RECENT FINDINGS:Careful consideration and selection is required in patients with co-existing corneal conditions who desire spectacle independence. Presbyopia-correcting IOLs have been shown to be safe and provide good uncorrected vision in eyes with previous CRS. Modern biometry formulas have improved predictability in eyes with previous CRS, though evidence related to presbyopia-correcting IOLs is limited. Pinhole IOLs may be suitable for eyes with irregular/aberrated corneas. Further evidence regarding presbyopia-correcting IOLs is required in eyes with dry eye disease, keratoconus, and corneal graft. Knowledge of the range of available IOLs are key to optimizing visual quality and achieving spectacle independence. SUMMARY:Patients with prior CRS or co-existing corneal disease(s) present unique challenges when considering presbyopia-correcting IOLs. While promising options are available, successful outcomes depend on careful patient selection, thorough corneal assessment, and realistic management of patient expectations.

A comparison of the accuracy of intraocular lens (IOL) power calculation formulae, including SRK/T, HofferQ, Holladay 1, Haigis, MM, Barrett Universal II (BUII), Emmetropia Verifying Optical (EVO), and AS-OCT ray tracing, was performed. One hundred eyes implanted with either the Rayone EMV RAO200E (Rayner Intraocular Lenses Limited, Worthing, UK) or the Artis Symbiose (Cristalens Industrie, Lannion, France) IOL were included. Biometry was obtained using IOLMaster 700 (Carl Zeiss Meditec AG, Jena, Germany) and MS-39 AS-OCT (CSO, Firenze, Italy). Mean (MAE) and median (MedAE) absolute errors and percentage of eyes within ±0.25D, ±0.50D, ±0.75D, and ±1.00D of the target were compared, with ±0.75D considered a key metric. The highest percentage within ±0.75D was found with MM (96%) followed by the Haigis (94%) for the enhanced monofocal IOL. SRK/T (94%) had the highest percentage within ±0.75D, followed by Holladay 1, MM, BUII, and ray tracing (all 90%) for the multifocal IOL. No statistically significant difference in MAE was found with both IOLs. EVO showed the lowest MAE for the enhanced monofocal and ray tracing for the multifocal IOL. EVO and ray tracing showed the lowest MedAE for the two respective IOLs. A similar performance with high accuracy across formulae was found. MM and ray tracing appear to have similar accuracy to the well-established formulae and displayed a high percentage of eyes within ±0.75D.

Background/Purpose: Meibomian glands are sebaceous glands that release meibum onto the ocular surface; enhancing the quality and quantity of meibum secretions has been proven to improve signs and symptoms of evaporative dry eye (EDE) and meibomian gland dysfunction (MGD). This study aimed to evaluate and compare the efficacy of a heated eye mask (HEM) and eyelid massage device EyePeace (EP) in alleviating signs and symptoms of evaporative dry eye. Methods: Forty dry eye participants were recruited in a prospective, contralateral-eye trial study. After undergoing 10 min of HEM therapy, eyelid massage therapy was applied to one eye by the device. The efficiency was assessed at four time points: baseline (0 min), 5 min (5 min), 15 min (15 min), and 30 min (30 min). Non-invasive breakup time (NITBUT), redness score (RS Score), tear meniscus height (TMH), tear-film lipid layer (TFLL), endothelial cell count (ECC), meibomian gland expressibility (MGEx), meibomian gland quality (MGQ), conjunctivocorneal staining (CS), ocular surface temperature (OST), best corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness (CCT) flat-axis keratometry value (K1), and steep-axis keratometry value (K2), were examined. Results: Baseline clinical measurements did not have statistically significant differences between the groups (all p > 0.05). After 30 min, a comparison was made between the HEM group and EP + HEM group, revealing significant changes only in the primary outcomes, TFLL (2.18 ± 0.45 versus 2.40 ± 0.50; p < 0.05), and MGEx grades (0.68 ± 0.53 versus 0.98 ± 0.70; p < 0.05). Improvements in NITBUT and TMH were sustained until 5 min and 15 min after using EP + HEM. No significant changes were observed in RS Score, MGQ, OST, CFS, BCVA, IOP, ECC, K1, K2, and CCT (all p > 0.05) at all test time points. Conclusion: The application of a heated eye mask followed by a gentle massage using EyePeace on the eyelids can have a sustained improvement in the tear film lipid layer and meibomian gland expressivity score but not clinically significant, and does not pose any significant immediate impact on the cornea.Trial registration number: NCT06158997.

PURPOSE:To assess whether the use of measured posterior corneal astigmatism (PCA) values improves the prediction accuracy of toric intraocular lens power formulas, compared to predicted PCA values, when the orientation of the steep axis of PCA is non-vertical. DESIGN:Retrospective observational cohort study. METHODS:Four hundred eighteen eyes of 344 patients were included in the study. Prediction errors (PE) for postoperative refractive astigmatism at 4 weeks postoperatively were determined using vector analysis and compared for the following toric intraocular lens power formulas: Barrett Toric with predicted posterior corneal astigmatism (PPCA); Barrett Toric with measured posterior corneal astigmatism (MPCA); EVO Toric PPCA; EVO Toric MPCA; Holladay I with Abulafia-Koch regression. Subgroup analysis compared PEs for eyes with a vertically orientated steep axis of PCA (60-120°) to eyes with a non-vertically orientated steep axis of PCA. SETTING:Cathedral Eye Clinic, Belfast, United Kingdom and Tan Tock Seng Hospital, Singapore. RESULTS:Standard keratometry was with-the-rule in 48% of eyes, while the steep PCA axis was vertically orientated in 91% of eyes. For all eyes, EVO-PPCA had a smaller mean absolute error than Barrett-MPCA, Barrett-PPCA, and Abulafia-Koch (P < .01 for all). EVO-PPCA had the highest percentage of eyes within 0.50D of predicted postoperative astigmatism for eyes with vertical PCA (61%), while EVO-MPCA had the highest percentage for eyes with non-vertical PCA (54%). EVO-MPCA had the smallest centroid error for all eyes, and the subgroups (P < .01 for all). Eyes with non-vertical PCA had a lower percentage within 0.50D than eyes with vertical PCA when using PPCA (43% vs 61%, P = .034), but there was no significant difference between these groups when MPCA is used for eyes with non-vertical PCA (54% vs 61%, P = .40). CONCLUSIONS:When the steep axis of posterior corneal astigmatism is not vertically orientated, the use of measured posterior keratometry values improves prediction accuracy.

Background The global prevalence of diabetes mellitus (DM) continues to rise and 70% of diabetic individuals have dry eye disease (DED) that leads to subsequent abnormalities of the corneal epithelium, corneal nerves, tear film, or corneal endothelium. In addition, persons with diabetes produce fewer tear secretions than healthy individuals. While several anti-inflammatory drug-based therapies for dry eye in diabetic individuals are currently being administered, their efficacy has not been studied in detail. Therefore, the aim of this study was to compare the effectiveness of 3% diquafosol (DQS) vs 0.1% hyaluronic acid (HA) eye drops in diabetic dry eye patients. Methods This triple-blind randomized, control trial will include 202 diabetic-related DED and will be assigned to DQS ( n = 101) and HA ( n = 101) one drop, six times per day for 8 weeks. Tear film lipid layer, non-invasive breakup time, conjunctivocorneal staining score, corneal sensitivity, tear MMP-9 levels, meibomian gland expression and quality, tear meniscus height, corneal nerves, immune/inflammatory cell change, conjunctival hyperemia, and ocular surface disease index questionnaire score will be assessed and compared at baseline, week 4, and week 8. Discussion This study will be a standardized, scientific, clinical trial designed to evaluate the therapeutic effects and safety of DQS and HA for diabetic dry eye treatment. Trial registration ClinicalTrials.govNCT05682547. Registered on December 05, 2022.

Purpose: To assess the 3-month and 12-month postoperative visual performance and subjective quality of vision (QoV) after combined implantation of complementary continuous phase multifocal intraocular lenses (IOLs). Setting: Private practice, United Kingdom. Design: Case series. Methods: The study enrolled 44 patients undergoing phacoemulsification with implantation of an Artis Symbiose Mid in the dominant eye and an Artis Symbiose Plus in the nondominant eye. Refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity, uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), electronic reading desk, and a QoV questionnaire were evaluated at 3 months and 12 months postoperatively. Results: The mean binocular UDVA was −0.06 ± 0.08 logMAR and −0.07 ± 0.06 logMAR at 3 months and 12 months ( P = .097), respectively. The mean binocular UIVA was 0.03 ± 0.13 logMAR and 0.03 ± 0.10 logMAR ( P = 1.0), respectively. The mean binocular UNVA was 0.07 ± 0.10 logMAR and 0.07 ± 0.08 logMAR ( P = .875), respectively. There was a significant improvement in QoV for both day and night between 3 and 12 months, with a significant reduction in halos at 12 months. Spectacle independence was reported in 93.2% of cases at 12 months. Conclusions: The Artis Symbiose Mid and Plus IOL combined implantation provided an excellent range of uncorrected vision at 3 and 12 months. There was a significant improvement in QoV and less halos at 12 months. This IOL combination provided very high rates of complete spectacle independence.

Introduction Evaporative dry eye (EDE) is common and can lead to ocular pain, decreased visual quality and reduced quality of life. Intense pulsed light (IPL) and 3% diquafosol ophthalmic solution have been found to be beneficial in reducing signs and symptoms of dry eye.Methods and analysis A randomised clinical trial will be performed at He Eye Specialist Hospital in Shenyang. 360 dry eye disease patients will be equally divided randomly into the IPL group, DQS group (3% diquafosol ophthalmic solution eye-drops) and IPL+group (IPL combined with 3% diquafosol eye-drops). All groups will be followed up for 4 weeks. The primary outcome measures will be the non-invasive tear break-up time and the Ocular Surface Disease Index change from the baseline. The secondary outcome measures willincludeconjunctival and cornea staining with fluorescein and lissamine, meibomian gland function and secretion quality, tear film lipid layer score, tear meniscus height, conjunctival hyperemia (redness score) changes . Adverse events also will be monitored and documented.Discussion This study aimed to assess whether the combination of IPL with 3% diquafosol ophthalmic solution (study group), IPL+ (study group), is more effective than IPL (active control group) or DQS (active control group) in participants with EDE.Ethics and dissemination Management of dry eye with IPL combined with 3% diquafosol ophthalmic solution, registered on 23 January 2023. Ethics approval number: IRB (2022) K029.01. The study's findings will be shared regardless of the effect's direction.Trial registration number NCT05694026.

This study assessed the efficacy and safety of intense pulsed light (IPL) therapy in participants with severe evaporative dry eye disease (DED). This randomized, controlled, single-center study included 49 adult participants (≥ 18 years) with severe evaporative DED who received either IPL therapy (n = 56 eyes) or sham therapy (n = 42 eyes) three times. The primary efficacy parameters were ocular surface disease index (OSDI) score, non-invasive tear breakup time (NITBUT), tear film lipid layer (TFLL), conjunctivocorneal staining score (CS), MG Score, meibomian gland (MG) quality, and MG expression score. The mean ages for the IPL group and the control group were 28.05 ± 3.41 years (57.1

Abstract Title: A protocol for a single center, randomized, controlled trial comparing the clinical efficacy of 3% diquafosol and 0.1% hyaluronic acid in diabetic patients with dry eye disease. {1} Background The global prevalence of diabetes mellitus (DM) continues to rise and 70% of diabetic individuals have dry eye disease (DED) that leads to subsequent abnormalities of the corneal epithelium, corneal nerves, tear film, or corneal endothelium. In addition, persons with diabetes produce less tear secretions than healthy individuals. While several anti-inflammatory drug-based therapies for dry eye in diabetic individuals are currently be administered but their efficacy not been studied in detail. Therefore, the aim of this study was to compare the effectiveness of 3% diquafosol (DQS) vs 0.1% hyaluronic acid (HA) eye drops in diabetic related dry eye patients. Methods and analysis: This single-blind randomized, control trial will include 140 diabetic related DED and will be assigned to DQS (n = 101) and HA (n = 101) one drop, six times per day for 8 weeks. Tear film lipid layer, non-invasive breakup time, cornea conjunctival staining score, corneal sensitivity, tear MMP-9 levels, meibum gland, tear meniscus height, corneal nerves and immune/inflammatory cells change, conjunctival hyperemia, ocular surface disease index questionnaire score will be assessed and compared at baseline, week-4, and week-8. Discussion This study will be a standardized, scientific, clinical trial designed to evaluate the therapeutic effects and safety of DQS and HA for diabetic related dry eye treatment. Ethics and dissemination: This study will be approved by the Ethics Committee of He Eye Specialist Hospital [ethics approval number: IRB (2022) K002.01]. Prior to participating in the trial, all patients will provide written informed permission. The outcomes of this study will be presented at local and international conferences and submitted for publication in journals with peer review. Trial registration number : Clinicaltrials.gov NCT04980144 {2a, 2b}

Background: Dry eye disease (DED) is a complex ocular surface inflammatory disorder with a multifactorial etiology. Therapies such as intense pulsed light (IPL) and heated eye mask (HEM) have been reported to improve the tear film lipid layer (TFLL) and signs and symptoms of DED. Methods: This randomized study aimed to compare the effects of IPL combined with HEM (IPL+HEM) group, IPL group, and control group in participants with evaporative DED. All participants were examined at baseline (D0), day 21 (D21), day 42 (D42), and day 84 (D84) for noninvasive tear breakup time (NITBUT), TFLL, corneal conjunctival staining (CS), meibomian gland quality (MGQ), meibomian gland expressibility (MGEx), and Ocular Surface Disease Index (OSDI). Results: The mean age of participants was IPL+HEM: 28.06 ± 3.88 years, IPL: 29.88 ± 4.68 years, and control: 28.52 ± 3.77 years. At D84, significant improvements in TFLL (p < 0.05), noninvasive tear breakup time (NITBUT) (p < 0.05), corneoconjunctival staining (CS) (p < 0.05), MGQ (p < 0.05), MGEx (p < 0.05), and OSDI (p < 0.05) were found in the IPL+HEM and IPL groups, whereas the control group had no significant improvements. Furthermore, ΔTFLL significantly correlated with ΔNITBUT (r = -0.678, p < 0.001), ΔCS (r = 0.321, p < 0.001), ΔMGQ (r = 0.669, p < 0.001), ΔMGEx (r = 0.598, p < 0.001), and ΔOSDI score (r = 0.649, p < 0.001). Conclusions: IPL therapy in combination with HEM and IPL therapy only can significantly improve the quality of TFLL and clinically reduce the sign and symptoms of evaporative DED. However, IPL therapy in combination with HEM was found to be more effective than IPL therapy alone.

Introduction The primary objective of this study is to assess whether the combination of intense pulsed light (IPL) with 3% diquafosol (DQS) ophthalmic solution is more effective than intense pulsed light in alleviating signs and symptoms of dry eye disease (DED). Methods This randomized study included 66 participants with evaporative dry eye (EDE) who received IPL + DQS therapy ( n = 44 eyes), IPL therapy ( n = 44 eyes), or sham therapy ( n = 44 eyes). All participants were examined at baseline (D0), day 14 (D14), and day 28 (D28) for non-invasive break-up time (NITBUT), tear-film lipid layer (TFLL), corneal conjunctival staining (CS), meibomian gland quality (MGQ), meibomian gland expression (MGEx), and ocular surface disease index (OSDI). Results At day 28, comparison among the IPL + DQS therapy, IPL therapy, and sham therapy found significant differences in the mean NITBUT (12.03 ± 1.27 versus 10.47 ± 3.48 versus 4.57 ± 0.46; p < 0.001), TFLL (2.09 ± 0.29 versus 2.27 ± 0.45 versus 2.89 ± 0.65; p < 0.001), CS (1.43 ± 0.82 versus 1.93 ± 1.32 versus 3.52 ± 1.00; p < 0.001), MGQ (1.55 ± 0.66 versus 1.91 ± 0.77 versus 2.66 ± 0.53; p < 0.001), MGEx (1.27 ± 0.45 versus 1.75 ± 0.44 versus 2.41 ± 0.50; p < 0.001), and OSDI score (19.36 ± 7.01 versus 24.77 ± 4.68 versus 42.61 ± 7.49; p < 0.001); significant improvements in NITBUT, TFLL, CS, MGQ, MGEx, and OSDI were found in the IPL + DQS therapy and IPL therapy, while the sham therapy had no significant improvements. Conclusion Combining 3% diquafosol ophthalmic solution with intense pulsed light was superior to IPL therapy alone in relieving the signs and symptoms of patients with severe evaporative DED. Trial registration Clinical Trials Identifier: NCT05694026

The global prevalence of diabetes mellitus (DM) continues to rise and 70