I’m motivated to post these studies about cataract surgery because we still have some years to go before it becomes the norm for all cataract patients to have a serious discussion about dryness with their surgeon before surgery.

But… I particularly liked this one because it does NOT involve fancy schmancy stuff. In some circles, the pendulum is swinging pretty far the other way, i.e. many doctors promoting costly cash-pay in-office MGD procedures prior to cataract surgery. This study looked at 120 patients with moderate obstructive MGD. Those who treated it post-operatively with the standard stuff (heat, hygiene, anti-inflammatory) had better MG status after surgery. (Might they have been even better off with one of those costly cash-pays? Dunno.)

Preoperative Management of MGD Alleviates the Aggravation of MGD and Dry Eye Induced by Cataract Surgery: A Prospective, Randomized Clinical Trial. Song P et al, Biomed Res Int. 2019 Apr 11;2019:2737968.

PURPOSE:
To investigate the effect of preoperative treatment and postoperative enhanced anti-inflammatory treatment on alleviating meibomian gland dysfunction (MGD) and dry eye induced by cataract surgery.
DESIGN:
Prospective, randomized clinical trial.
METHODS:
A total of 120 cataract patients with moderate obstructive-MGD were enrolled and randomized with 60:30:30 number of patients in cohorts I, II, and III, respectively: Cohort I: routine postoperative anti-inflammatory treatment; Cohort II: preoperative treatment (warming compress, lid hygiene, and anti-inflammatory treatment) and routine postoperative anti-inflammatory treatment; Cohort III: enhanced postoperative anti-inflammatory treatment.
MAIN OUTCOMES MEASURES:
All participants were examined preoperatively and postoperatively for ocular symptom score (OSS), noninvasive keratographic tear break-up time (NIKBUT), corneal fluorescein staining, Schirmer I test, lid margin, meibum quality and expressibility, and meibomian gland dropout.
RESULTS:
Ocular surface disorders and MGD showed aggravated status at 1 month postoperatively in Cohort I and Cohort III, and the aggravated MGD resolved by 3 months postoperatively. At 1 month postoperatively, Cohort II and Cohort III presented high NIKBUT and low OSS, lid margin, and meibum quality and expressibility (Cohort II vs Cohort I: all P<0.001, respectively; Cohort III vs Cohort I: P=0.011, P=0.024, P=0.046, P=0.045, and P=0.012, respectively). Additionally, Cohort II had better outcomes of lid margin and meibum quality and expressibility than Cohort III at 1 month postoperatively (P=0.031, P=0.026, and P<0.001, respectively). At 3 months postoperatively, Cohort II presented a significantly higher NIKBUT than Cohort I and Cohort III (P<0.001 and P=0.001, respectively).
CONCLUSION:
Preoperative management of MGD is effective and optimal in alleviating obstructive-MGD and dry eye induced by cataract surgery.