Eyeworld

I NOVEMBER 2019 | EYEWORLD | 45 Contact information Chamberlain: chamberw@ohsu.edu Colby: kcolby@bsd.uchicago.edu Terry: MTerry@deverseye.org surgery … glasses independence is just not a reasonable expectation." Dr. Chamberlain said he would consider a premium lens in a patient who has had prior DMEK. Dr. Terry bases his IOL calculations on the likelihood of a hyperopic shift, aiming for –0.8 for DMEK, –1.25 for DSAEK, and –0.5 for DSO. Dr. Colby targets her IOL calculations to 0.75–1 D myopic, knowing that DSEK would bring them closer to plano, while with DMEK or DSO she leaves them 0.5–0.75 myopic. Dr. Chamberlain said that he targets –0.5 D with DMEK and ultra-thin DSAEK. DSO can have an early myopic shift in the cornea, Dr. Cham- berlain continued, adding that more long-term data is needed about how it stabilizes. None of the doctors saw a distinct benefit for using the femtosecond laser for cataract surgery in these cases. Dr. Colby said that while, theoretically, softening the lens with a femto- second laser could reduce phaco time in the eye and thus spare endothelial cells, its benefits are not born out in peer-reviewed literature. Studies have compared conventional phaco and femtosecond laser-assisted cataract surgery in eyes with Fuchs', finding less endothelial cell loss in the FLACS group, 2,3 but a study of 207 eyes with Fuchs' comparing conventional phaco and FLACS did not see a difference in corneal decompensation rates. 4 Dr. Terry also pointed out that if you were doing a combined procedure, sparing recipient endothelial cells of a cornea that is about to have an endothelial keratoplasty procedure that removes them is not a concern. "If you think you can get away with cata- ract surgery without having to do a transplant, I think you should use whatever technique you think causes the least amount of damage," Dr. Terry said. The doctors provided a few final thoughts on the topic of irregular astigmatism in patients with Fuchs' who need cataract surgery. Dr. Colby stressed the Sun et al. paper because it "has the potential to change the way we evalu- ate Fuchs' patients." Dr. Terry said it's import- ant to address Salzmann's nodules and pterygia, which could be the cause of significant irregular astigmatism. Dr. Chamberlain noted increasing numbers of phakic DMEK surgeries and emphasized how DMEK grafting first can normalize the cornea and allow for better refractive IOL pre- diction staged at a later date. "We've also been surprised to see that some of our Fuchs' patients are able to postpone cat- aract surgery for a considerable period of time because their vision improves so much from the DMEK alone," he said. ASCRS eyeworldtv.com Sumit "Sam" Garg, MD, and others from the 2019 ASCRS ASOA Combined Ophthalmic Symposium Relevant financial interests Chamberlain: None Colby: None Terry: None

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