Eyeworld

JULY 2023 | EYEWORLD | 67 C Contact Beckman: kenbeckman22@aol.com Fikry: ramyriadfikry@kasralainy.edu.eg Garg: gargs@uci.edu Rocha: karolinnemaia@gmail.com Rostov: atalleyrostov@nweyes.com Santhiago: marconysanthiago@hotmail.com Shamie: ns@maloneyshamie.com Sorkin: nir.sorkin@gmail.com Trattler: wtrattler@gmail.com Relevant disclosures Beckman: None Fikry: None Garg: None Rocha: None Rostov: None Santhiago: None Shamie: Alcon, Bausch + Lomb, CorneaGen, Glaukos, RxSight, Johnson & Johnson Sorkin: None Trattler: Alcon, Allergan, ArcScan, Bausch + Lomb, Carl Zeiss Meditec, Johnson & Johnson Vision, Oculus, STAAR Surgical Case 4: Older patient with stable keratoconus for cataract eval This case of a high myope with stable keratoco- nus (OD: –11–1.00x080, OS: –12–2.75 x123) was presented by Audrey Talley Rostov, MD. In cases like this, she tends to use the Barrett True K formula for IOL calculations, but she men- tioned the Kane formula as well. Dr. Rostov asked the panel if they would consider a toric IOL in this patient. Dr. Garg said he'd want to know if they had good vision in glasses in the past; if not, he would steer away from a toric. Contact lenses are an option as well, but Dr. Rostov said many of her older patients want to get away from contact lens use. Dr. Rostov ended up implanting a toric IOL, using the femtosecond laser for axis alignment. She said that keratoconus patients receiving to- ric IOLs aren't necessarily expecting perfection, but IOL alignment is important, and she avoids multifocal and EDOF IOLs. Dr. Garg said that it's not just about nailing the cylinder in these cases, it's about nailing the sphere and trying to avoid ending up hyperopic. Case 5: Young patient with keratoconus wants refractive options A 28-year-old male firefighter with a history of congenital anterior polar cataracts, keratoconus (right eye more advanced), and a history of con- tact lens intolerance wanted to know what his refractive surgery options were. Karolinne Rocha, MD, PhD, presented the case, sharing that his uncorrected visual acuity in his right eye was count fingers (MRx –3.5–4.5x070, correctable to 20/60). His K max was 54 D and progressed to 58 D 6 months later. Dr. Rocha said she decided to do a com- bined Intacs (CorneaGen) and crosslinking procedure. Even though the magnitude of his astigmatism was still high after Intacs, she said with glasses he could see 20/30. A couple of years later he returned with his cataract worse and visually significant, and Dr. Rocha said she used the Kane Keratoconus formula to calculate for a toric IOL. Using a monofocal T9 (6.00) toric IOL, there was still residual cylinder, but Dr. Garg said that these patients are often accepting of some residual astigmatism. His final refraction, according to Dr. Rocha, was +0.75+2.5x165 20/25. "Combined procedures have been shown to have a greater effect in the treatment and improvement of visual acuity and quality in pa- tients with keratoconus. Concurrent or sequen- tial procedures are great alternatives to patient intolerance to contacts," she said. Case 6: Patients in their 40s with keratoconus want to know if they're a good candidate for crosslinking Ramy Riad Fikry, MD, PhD, shared two cases where patients in their 40s were seeking a second opinion on whether they should have crosslinking. One was a 40-year-old man who didn't have a family history of keratoconus and learned of his diagnosis when he was seeking out refractive surgery. The patient was fol- lowed up with after his initial second opinion consultation after 6 months, showing a stable condition in both eyes. Dr. Fikry said he tested the patient's corneal biomechanics and other metrics that would detect changes before loss of lines, finding the patient was stable without the need for further intervention. The second case, however, showed significant progression and proceeded with crosslinking treatment. "Combined procedures have been shown to have a greater effect in the treatment and improvement of visual acuity and quality in patients with keratoconus." —Karolinne Rocha, MD, PhD

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