Impact of Corneal Punctate Epithelial Staining on Patient Satisfaction After Cataract Surgery: An Area of Unmet Need for Clinical Guidance.

PURPOSE: The goal of this study is to review the existing evidence to quantify the impact of corneal punctate epithelial erosions (PEE) on postoperative refractive error-related patient dissatisfaction after cataract surgery.

METHODS

PubMed and the Cochrane library were systematically searched for studies using the terms "dry eye" or "dry eye disease" or "punctate epithelial erosions" or "corneal staining" combined with "biometry" or "keratometry" or "cataract surgery." ChatGPT was also queried using the same search terms to identify any potentially relevant publications that might have been missed. All retrieved publications and their references were examined, and the results were tabulated.

RESULTS

A total of 1446 abstracts were identified through online search, corresponding to 1242 unique publications. Of these, 12 studies were deemed relevant and full articles were retrieved. ChatGPT identified an additional 6 unique publications. None of the 18 studies reviewed in detail, however, quantified the impact of PEE on biometry assessments. The results of 8 studies reporting on 4 other dry eye disease parameters that informed the impact on biometry results were summarized.

CONCLUSIONS

Despite the current emphasis on optimizing corneal PEE before biometry, no studies define thresholds or metrics linked to measurable effects on postcataract visual outcomes. This review highlights the need for future studies to inform algorithms used for preoperative cataract decision making.