Eyeworld

SPRING 2024 | EYEWORLD | 61 C References 1. Sandhu U, et al. Comparison of IOL calculation formulas for long and short axial length eyes. Invest. Ophthalmol Vis Sci. 2023;64(8):1203. Relevant disclosures Bedrood: Abbvie, Glaukos, Thea Laboratories, Ocular Therapeu- tix, BVI, Elios Vision Giaconi: LightTouch Dr. Bedrood said that, in the past, the for- mulas that were suggested for use in short axial length eyes were the Haigis and Hoffer Q for- mulas. "There are newer formulas that we now implement into our practice," she said, adding that the K6 formula and the Kane formula are multivariate formulas that have shown good success for obtaining targeted refractive out- comes in the shorter eyes. 1 Short eyes are more difficult to operate in, Dr. Giaconi said. There can be more positive posterior pressure; the anterior chamber is often shallow; the capsulorhexis can have a tendency to run out; and iris prolapse is more common, which can lead to iris damage. "For shorter eyes, I will administer IV man- nitol about an hour before surgery (20 grams), if the patient can tolerate it. This dehydrates the vitreous and removes positive posterior pres- sure," Dr. Giaconi said. If mannitol isn't safe, some people will use acetazolamide preoper- atively, she said. If the AC is very shallow, a limited pars plana vitrectomy can be done. "If one isn't comfortable doing this themselves, one can partner up with a retina surgeon to do it, especially if a retina surgeon operates on the same day as you in your operating rooms," she said. "It takes them just a couple of minutes to complete and can significantly deepen the ante- rior chamber and make operating much easier." Dr. Bedrood said the initial surgical chal- lenge with these eyes is the posterior pressure and the small space within the anterior cham- ber, which makes it challenging to maneuver instruments. She also recommended using IV mannitol preoperatively to help decompress the vitreous and move the lens more posteriorly. "I also recommend femtosecond laser for the rhexis so that there is less potential for the cornea to be touched by instruments during the creation of the rhexis," she said. "Other considerations include the possibility of iris prolapse, so I will have iris hooks on standby." seen due to the thin profile and enhanced by the fluorescein dye. Typically, the area of loose epithelium is isolated and well-demarcated. We published a study using the corneal sweeper to detect these hard-to-find corneal erosions and discovered that more than 80% of these patients experienced some improvement or resolution of symptoms after treatment. 1 " See "Corneal sweep test for recurrent corneal erosion" from the June 2022 issue of EyeWorld for more details on the technique. Management process The treatment for FBS depends on the under- lying cause. Since foreign body sensation can be due to various factors, Dr. Sayegh suggested some general approaches and treatments: 1. Identify and treat the underlying condition. Remove any foreign bodies and ex- posed concretions, optimize the ocular surface. Treat conditions appropriately with antibiotics, antihistamines, and/or steroids. Hypertonic saline can help with corneal edema and epi- thelial basement membrane dystrophy. Use lid hygiene for meibomian gland dysfunction and blepharitis. Response to therapy can sometimes help determine the main underlying cause of the FBS, and optimizing that line of treatment, whether it is using plugs in patients who find artificial tears helpful or cyclosporine in patients who find steroids helpful, can increase the odds of success. 2. Placing a drop of proparacaine in the eye and asking if it helps relieve the FBS can help diagnose corneal nerve dysfunction. Warm compresses not only help with blepharitis and meibomian gland dysfunction but seem to help reduce nerve pain as well. Autologous serum tears remain the most effective treatment for the neuropathic form of FBS and have been shown to help regenerate corneal nerves on confocal microscopy. Scleral lenses can also be helpful in some cases. 3. Avoid rubbing. Rubbing the eyes can ex- acerbate irritation and FBS. Dr. Sayegh has used wristbands that vibrate when patients attempt to touch their eyes (designed for trichotilloma- nia) with some success. continued from page 59

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