Eyeworld

EW CATARACT 35 October 2018 "Normally, I advise patients against putting anything into their operated eye that might flush skin bacteria onto the ocular surface," Dr. Miller said. "Patients often drop artificial tears on the side of their nose and roll them into the eye, so contamination can happen. I tell patients to wait to use artificial tears until the end of the first week when the infection rate is much lower." A couple of days postop, the pa- tient's eye became very dry and he repeatedly called with complaints that he could no longer see. "At that point, I recanted and let him go back to instilling artificial tears," Dr. Miller said. The patient's inability to close his eye will cause dry eye and other problems. Dr. Miller's ongoing treat- ment will include careful assessment of his cornea, tracking the glaucoma damage, and determining if there are other posterior segment or optic nerve problems. "One-eyed patients are compli- cated, and I see a lot of them," Dr. Miller said. "But I hadn't previously encountered a deaf one-eyed patient with a posterior polar cataract, glaucoma, limited visual field, and exposure keratopathy. That made it interesting and challenging." EW Editors' note: Dr. Miller has no finan- cial interests related to his comments. Contact information Miller: kmiller@ucla.edu After placing a single-piece acrylic lens in the capsular bag, Dr. Miller closed and patched the eye. About an hour later, once the patient was fully awake, he took the patch off and the patient was able to see and sign to him. Dr. Miller noted that no cur- rently available single-piece acrylic lens would have been suitable for implantation in the ciliary sulcus in the event of a large posterior capsule tear. A round edge lens is essential for this space because it comes into contact with the iris. "The beauty of femto is that the capsulorhexis is exactly sized and centered, so if I did have a rupture, I could put in my backup lens and capture the optic inside the capsu- lorhexis," Dr. Miller said. His backup lens was a three- piece collamer model with a 6 mm optic. Postop care Preop, the right eye's best correct- ed vision was 20/40 –1. One day postop, the patient's uncorrected vision was 20/40 ±2, and the patient viewed it as better than it had been in several years. "Presumably it will be a lot better as it heals, depending on the extent of optic nerve damage, but clearly, he was much better postop day 1," Dr. Miller said. Dr. Miller had advised the pa- tient against the immediate postop use of artificial tears to avoid con- tamination of the incision. Visit us at AAO 2018 in Booth #2939 w w w. i n n o v a t i v e x c i m e r. c o m AMOILS EPITHELIAL SCRUBBER Uniform epithelium removal in 5 7 seconds Corneal Xlinking Improved clinical outcomes of CXL and PRK with Amoils Epithelial Scrubber • Minimize total procedure time • Avoid alcohol damage to surrounding tissue • No need for subsequent scraping order online www.innovativexcimer.com T.800.461.1200 www.innovativexcimer.com Achieve superior results with This image shows the intraocular lens within the capsular bag before the incisions were hydrated. A small, round remnant plaque can be seen against the posterior capsule. The plaque was left in the eye and not polished off as the capsule was likely to be thin in this area. The plaque will be removed using a Nd:YAG laser later if it bothers the patient. Source (al): Kevin Miller, MD

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