Eyeworld

58 | EYEWORLD | MARCH 2021 ATARACT C Contact Charles: scharles@att.net Devgan: devgan@gmail.com Weng: christina.weng@bcm.edu She said it's important to remind AMD patients that their surgical outcomes may not match those of their friends and neighbors with- out retinal disease. "Assessing patients' visual potential through examination and imaging is critical in this cohort so that their expectations can be properly set." In terms of timing of surgery with any intravitreal injections, Dr. Weng said that she tries not to disrupt the schedule of intravitreal injections in wet AMD patients, although she prefers not to inject on the first postoperative day. "Timing the surgery so it falls between injections is ideal if possible," she said. When handling a patient with AMD, Dr. Devgan said he will coordinate care with retinal colleagues, and for most of these patients, the best choice is a monofocal IOL and a goal of plano spherical equivalent. "We explain to the patient that the eye is like a camera; with cataract surgery, we are changing to a new and improved lens, but the film of the camera, the retina, is still affected by the macular degen- eration," he said. "If the retina doctor deems that an intravitreal injection is needed prior to the cataract surgery, we will certainly heed that advice." Cataract surgery after pars plana vitrectomy or intravitreal injections When performing cataract surgery after a pars plana vitrectomy or intravitreal injections, Dr. Charles said to look for vitrectomy-related de- fects in the posterior capsule in the office with a widely dilated pupil and remain cautious and aware during cataract surgery. Patients with a history of pars plana vit- rectomy may pose surgical challenges due to weakened zonules, posterior capsular violation, floppy capsule due to absence of vitreous, or poor dilation, Dr. Weng said, adding that intra- vitreal injections have also been associated with weakened zonules, as well as an increased risk of posterior capsular rupture. 3 "Having multi- ple types of IOLs and iris expansion/capsular tension stabilizing devices available as well as avoiding significant traction on the zonules during phacoemulsification is advisable," she said. Dr. Weng advised hydrophobic acrylic monofocal IOLs as the safest choice for patients with wet or dry AMD. "Presbyopia-correcting IOLs should be used with caution because of possible degradation in contrast vision and an approximately 15% loss of light from diffractive optics," she said. "It may be beneficial to aim for distance vision so that the plus spectacles used for reading provide an added magnification boost." Dr. Weng added that she does not routinely bring a patient in for a dedicated preop retinal check, assuming dry AMD patients are already being regularly followed and that wet AMD pa- tients are on an established treatment regimen. "However, this again assumes that the cataract surgeon is obtaining a preoperative OCT in all patients to confirm no changes from baseline," she added. "If not, I am always happy to see the patient beforehand." continued from page 57 A 68-year-old patient with dry AMD (bottom) had a single-piece acrylic monofocal IOL placed in the capsular bag (top) during cataract surgery. Source: Christina Weng, MD, MBA

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