Purpose: To investigate the safety and efficacy of the intraoperative use of a triphasic polymeric gel as corneal coating during cataract surgery and its effect on postoperative ocular comfort.

Background: The corneal coating gel reduces corneal injury and improve patient comfort. In the present study we monitored inflammation and epithelial remodelling parameters in coating gel- and BSS-treated eyes up to 30 days postop.

Purpose: To study the effects on corneal surface and discomfort syndrome after cataract surgery using intraoperative tripolymeric coating gel.

Methods: 25 eyes received the corneal coating gel during surgery; 25 eyes were irrigated with BSS (control). Anterior segment optical coherence tomography (central corneal thickness (CCT), epithelial thickness (ET), confocal microscopy, and ocular surface disease index (OSDI) were administered preoperatively (baseline), 1, 5, and 14 days postoperatively.

Results: In the BSS-irrigated eyes, all the parameters changed in postop period and came back to the baseline values after 30 days. In the gel-coated eyes, only CCT and ET increased significantly 1 day postop, whereas all the parameters remained similar to the baseline at all follow-up intervals. OSDI was better in the coating gel group.

Conclusion: The use of intraoperative coating gel reduced the effects of surgically induced trauma and improved ocular comfort.

Purpose: To compare the protective properties and ease of manipulation during cataract surgery of corneal coating with a gel (eyeDRO; AL.CHI.MI.A. S.R.L, Italy) and corneal irrigation with balanced salt solution (BSS).

Methods: We analyzed the data of 51 patients receiving either eyeDRO or BSS during routine cataract surgery performed within a 20-day period in 2016. The selected parameters were intraoperative clarity and ease of manipulation; postoperative epithelial integrity; and patient discomfort.

Results: Compared with BSS irrigation, eyeDRO coating significantly increased intraoperative clarity and ease of manipulation (P < 0.01). Single application was required in eyeDRO-treated eyes, whereas BSS was applied 5.3 ± 0.4 times on average (P < 0.01). Two hours postoperatively, a normal epithelium was observed in 90.0% and 60.0% of eyeDRO-coated and BSS-irrigated eyes, respectively; punctate epithelial damage was observed in 9.7% and 40.0% (P < 0.05) of eyeDRO-coated and BSS-irrigated eyes, respectively; eye irritation and foreign body sensation were experienced by 13.0% and 37.0% of eyeDRO-treated patients and by 65.0% and 100% of BSS-treated patients, respectively (P < 0.01). Twenty-four hours postoperatively, 80.0% of BSS-treated patients versus 19.0% of eyeDRO-treated patients still experienced foreign body sensation (P < 0.01).

Conclusions: eyeDRO coating was shown to be a safer and more effective option than BSS irrigation in cataract surgery because single application provided optimal hydration and intraoperative clarity during the entire surgery, better preserved the corneal epithelium, and offered postoperative comfort to the patient.

Purpose: Standardization of dropless cataract surgery consisting in minimal preoperative preparation and elimination of intraoperative BSS irrigation.

Setting: POLIVISUS, via A Moro 34, Brescia, Italy, Private Ophthalmology Clinic.

Methods: Sixty cataract patients were enrolled in a prospective study. “Dropless Surgery group” included forty eyes receiving Mydriasert ophthalmic insert (Laboratories Thea, France) and single application of eyeDRO corneal coating (Alchimia, Italy), before surgery. Control group included 20 eyes receiving topical mydriatics (Visufarma, Italy) preoperatively and irrigation with BSS (Alcon, USA) during surgery. All patients underwent phacoemulsification cataract surgery using Infinity equipment (Alcon, USA). Surgeon scored clarity of operative field and ease of manipulation at different intervals. Eye transparency was examined by slit lamp (Nikon, Japan), and epithelial damage by fluorescein staining, 2 hours postoperatively. All patients filled a self-assessment questionnaire.

Results: Corneal transparency and operative field clarity were significantly better in “Dropless Surgery group” than in Control group at each time interval. No eyes in “Dropless Surgery group” required further application of eyeDRO during surgery. Six irrigations were required on average in Control group with use of 13,6ml BSS per procedure. Frequency and volume of irrigation were increased in eyes with reduced transparency. Two hours postoperatively, 10% and 57% of patients showed moderate fluorescein staining in Dropless Surgery and Control group, respectively. 20% of patients in “Dropless Surgery group” reported foreign body sensation 24h postop compared to 86% in control group.

Conclusions: Dropless cataract surgery allowed to increase significantly the clarity of the operative field, facilitated surgical manipulation and improved patient comfort as compared to BSS irrigation procedure. Dropless cataract surgery permitted to minimize the variability related to preoperative preparation and intraoperative irrigation, and then resulted in simplification and standardization of the outcome of the phacoemulsification cataract surgery.

Purpose: To report the cases of cataract patients characterized by poor visibility of the operative field which was significantly improved with use of eyeDRO gel.

Setting: POLIVISUS, private ophthalmology clinic, via A Moro 34, Brescia, Italy.

Methods: Cataract patients with poor visibility of the operative field due to severe dry eye syndrome, corneal epithelium damage, cloudy/opaque cornea, deep set eyes and iatrogenic corneal abrasions are described. All patients received topical anesthetics and Mydriasert ophthalmic insert (Laboratories Thea, France) preoperatively and continuous 2-mm layer of eyeDRO gel (Alchimia, Italy) as corneal surface coating before surgery. All patients underwent phacoemulsification cataract surgery using Infinity equipment (Alcon, USA). Surgeon scored intraoperative clarity of operative field at different intervals and all the surgeries were filmed.

Results: In patients with severe dry eye, corneal epithelium damage, iatrogenic corneal abrasions, the application of the eyeDRo coating completely reestablished the transparency and visibility of the operative field. In deep set eyes the single application of the gel protected the corneal surface during all the surgery and facilitated the manipulation. Pseudoexfoliation syndrome was clearly detected in eyeDRO treated eye thank to the excellent intraocular visibility.

Conclusions: In patients characterized by poor visibility of the operative field during phacoemulsification cataract surgery, the single eyeDRO gel application restored visibility and protection of corneal surface significantly better than BSS irrigation.

Purpose: eyeDRO is a novel corneal gel intended to maintain corneal hydration and clarity during eye surgery. The aim of the present study was to evaluate the effect of the gel on intraoperative and postoperative corneal transparency, epithelial damage and patient discomfort in phacoemulsification cataract surgery as compared to balanced salt solution (BSS) irrigation.

Methods: Fifty uncomplicated cataract patients, aged from 50 to 83 years, were enrolled in a prospective  study. Thirty patients underwent phacoemulsification cataract surgery using Infinity equipment (Alcon, USA) and a single application of eyeDRO (Alchimia, Italy) as corneal surface coating. Twenty control eyes were irrigated with BSS solution (Alcon, USA). Surgeon scored intraoperative clarity of operative field and ease of manipulation. Two and 24 hours postoperatively, eye was examined by slit lamp (Nikon, Japan) for transparency. Extent of epithelial damage was determined by fluorescein staining and all patients filled a questionnaire on eye discomfort.

Results: Surgeon reported excellent clarity of operative field and ease of manipulation in 98% and 78% of eyeDRO-treated and control eyes, respectively. Postoperative slit lamp evaluation showed similar corneal transparency for both groups. Incidence of superficial punctiform keratitis was lower in eyeDRO group than in control group. Fluorescein staining showed a significant reduction of epithelial damage in eyeDRO group. Postoperative eye irritation and foreign object sensation was reported by 9% and 28% patients treated with eyeDRO and BSS, respectively.

Conclusions: The new eyeDRO gel exhibited an excellent clarity and stability of operative field, along with protective effects on corneal epithelium and significant reduction of patients discomfort as compared to BSS corneal irrigation during phacoemulsification cataract surgery.