Eyeworld

70 | EYEWORLD | DECEMBER 2021 C ORNEA by Ellen Stodola Editorial Co-Director About the physicians John Hovanesian, MD Harvard Eye Associates Laguna Hills, California Terry Kim, MD Chief of the Cornea and Refractive Surgery Service Duke University Durham, North Carolina Christopher Rapuano, MD Chief of the Cornea Service Wills Eye Hospital Philadelphia, Pennsylvania Julie Schallhorn, MD Residency Program Associate Director University of California San Francisco San Francisco, California I t's important for surgeons to be aware of preexisting corneal conditions that could have an impact on outcomes prior to cat- aract surgery. Several surgeons discussed some of the conditions to look for, tests to use, and how to treat before proceeding with cataract surgery. Common corneal conditions There are several common corneal disorders that can affect cataract surgery outcomes, said Julie Schallhorn, MD. Starting with the anterior corneal surface, significant epithelial abnormal- ities can impact keratometry and alter the plan for cataract surgery, she said. These conditions include epithelial base- ment membrane dystrophy (EBMD) and severe dry eye. Severe dry eye is usually easy to spot, Dr. Schallhorn said, but EBMD can be subtle. "Both of these can significantly impact keratom- etry and result in IOL calculation errors, which can sometimes be substantial," she said. Salzmann's nodules and pterygia are two other conditions that can significantly affect keratometry readings. "Pterygia are usually easy to spot, but sometimes even small ones can have a significant impact on keratometry," Dr. Schallhorn said. "You should always correlate the clinical exam with topography in these cases and look for evidence of flattening in the area of the pterygium." Salzmann's nodules can be much more subtle, she said, but are important to diagnose and treat before cataract surgery. "Something that I am encountering more and more is patients who previously had LASIK or PRK but forgot that they ever had it," Dr. Schallhorn said, adding that a LASIK flap can be detectable on exam, but patients who had PRK can have a completely normal corneal exam. For these patients, Dr. Schallhorn said looking at the topography is critical to detect the characteristic changes of prior ablation. There are less common things that can have an impact on cataract surgery as well, she said. These may include ectatic disorders, stromal keratitis, or corneal scars. "All of these are im- portant to note and correlate with topography for surgical planning." Additionally, Dr. Schallhorn said that an endothelial condition to recognize is Fuchs Looking for corneal disease prior to cataract surgery This relatively small pterygium does not involve the visual axis but did cause some irregularity on corneal topography. Removal should be considered prior to cataract surgery.

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