Epithelial Basement Membrane Dystrophy And Refractive Cataract Surgery: A Double-Pass Aberration Study

Epithelial basement membrane dystrophy (EBMD) is a corneal surface disorder more commonly observed in the elderly. It is often ignored by affected patients, and not always evident at the pre-operative clinical observation. This paper points out the importance of diagnosing EBMD in refractive cataract surgery.

Private Practice Verona, Italy

This study included 25 patients complaining of blurred vision after cataract surgery and with no history of corneal disorders and implanted with monofocal IOL. They were screened for EBMD by slit lamp examination and anterior OCT measurements, and analysed with a double-pass ocular aberrometer (OQAS II). The results were compared with 25 pseudophakic patients implanted with the same IOLs with no visual complaint. The prevalence of EBMD, the OQAS scattering index (OSI), and the 50% MTF cutoff were the main outcome measures.

Out of the complaining patients, 8 were diagnosed with EBMD, 7 with dry eye not related with EBMD. No abnormality of the ocular surface was found in 10 patients. The OSI index was 4.2±1.3 in the EBMD eyes, 1.8±0.7 in the dry eyes, and 0.8±0.3 in normal eyes. The difference between the EBMD and the normal eyes was significant (P<0.001). The 50% MTF cutoff values (cycles / degree) were 18±10, 29±15, and 41±14 respectively (P<0.001 between EBMD and normal).

Undiagnosed EBMD may be discovered only after cataract surgery. It can affect both the corneal transparency and the refractive result, leading to patient dissatisfaction even with monofocal IOLs. It exaggerated the optical disturbances typical of dry eye in this study. EBMD should be looked for in any patient candidated to refractive cataract surgery, and in any patient dissatisfied with refractive cataract surgery.