Eyeworld

I AUGUST 2019 | EYEWORLD | 49 CATARACT SURGERY POST-LVC he knows it is a microkeratome flap or it is old enough that it likely is. Other than epithelial ingrowth, Dr. Walton thinks that there's more accuracy in retreating LASIK than doing PRK over the flap. Rather than a younger refractive patient eye, these are cataract patients who have had decades of decompensation, he said, so you cannot assume their epithelium will grow back in the same pattern and thickness. "Seldom does a week pass where I'm not operating on someone who's post-LASIK, PRK, or RK," Dr. Miller said. When it's neces- sary to do an enhancement, Dr. Miller will often choose surface ablation or PRK on top of the flap for previous LASIK eyes. When you lift flaps more than a year out, you often get epithe- lial ingrowth, he said, and that's a headache for everyone. "As much as PRK is painful for the patient during the recovery period, it's the safer option," Dr. Miller said. He added that in post- RK eyes, a lens exchange may be necessary. Light Adjustable Lens The Light Adjustable Lens (LAL, RxSight) is beginning to be used commercially in practice. acknowledge the decrease in near that comes from correcting a slightly myopic result. "I offer both LASIK and PRK, depending on the ocular surface of the patient," he said. "Most patients prefer the faster and more com- fortable recovery of LASIK." Enhancements with previous LASIK for postop cataract patients Dr. Rebenitsch offers LASIK whenever possi- ble, and with the proper technique, he will lift an old flap (assuming he can see the edges of it). "We typically offer PRK when we're unsure of the previous flap-making technology," he said. Dr. Rebenitsch said that it's extremely im- portant to obtain epithelial thickness mapping when doing PRK after previous surgery. "I truly believe epi mapping is going to be not only common but necessary when treating post-re- fractive eyes in the future," he said. Dr. Walton said the older the flap, the more likely it is to be microkeratome. "In my mind, that's a greater risk for epithelial ingrowth af- terward because we don't have the squared off edge that we have with femtosecond flaps." He added that he would consider surface ablation if About the doctors Kevin M. Miller, MD Kolokotrones Chair in Ophthalmology David Geffen School of Medicine at UCLA Los Angeles Luke Rebenitsch, MD ClearSight LASIK Oklahoma City Julie Schallhorn, MD Assistant professor of ophthalmology University of California, San Francisco Bennett Walton, MD Slade & Baker Vision Houston continued on page 50 Superficial punctate keratopathy can significantly degrade quality of vision following cataract surgery.

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