EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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SUMMER 2024 | EYEWORLD | 41 C Relevant disclosures Al-Hashimi: None Tonk: None Contact Al-Hashimi: alhashimi@jsei.ucla.edu Tonk: rtonk@med.miami.edu With patients, he said he emphasizes that their cataract surgery is a once-in-a-lifetime proce- dure that with preop surface optimization can lead to better outcomes. This, he said, gets them on board with the procedures they might need preop and the delay they could cause to their cataract surgery. Postop management If ABMD is discovered to be the cause of quality of vision issues and/or ocular irritation postop, Dr. Tonk said first and foremost to be honest with the patient. "Most patients are glad to know there is a specific reason for their postoperative issues. Once you're on the same page with the patient, they typically want to work hand-in-hand with you to get better," Dr. Tonk said. Management of the condition depends on the nature of the patient's symptoms. If the symptoms include mild irritation and some vision fluctuation in a patient with minimal refractive demands, Dr. Tonk is more conserva- tive in his treatment, using lubricants, topical eye drops, a light steroid, and watchful waiting as the patient continues to heal. He said it's likely this patient's ABMD will settle down to an acceptable level. Another scenario is the patient who re- ceived a toric IOL and is finding that their vision is unclear postop. ABMD, Dr. Tonk said, can throw off the amount of astigmatism. He said he would follow the same topical protocol as described previously and, if necessary, would consider a procedure. In the right situation, a one-time PRK could treat the ABMD and the re- sidual refractive error, but Dr. Tonk said it may be necessary to stage superficial keratectomy followed by PRK for the best outcome. In a third scenario, Dr. Tonk laid out the experience of a patient with a diffractive mul- tifocal IOL. He said to pay extra attention to the symptoms related to quality of vision. He starts with a similar protocol—topical therapy and possible procedural treatments—for these patients. But if quality of vision is notably af- fected, he has a low threshold to exchange the diffractive IOL for a monofocal, EDOF, or the Light Adjustable Lens (RxSight). Dr. Tonk said he likes to avoid getting to these situations, with preoperative identification being critical. Areas of negative staining highlighted with fluorescein and cobalt blue filter Source: Anthony Aldave, MD Slit lamp photograph of map lines and epithelial cysts Source: Anthony Aldave, MD What's in a name? ABMD EBMD Map-dot-fingerprint dystrophy Cogan's microcystic corneal dystrophy Anterior basement membrane dystrophy, ABMD as it's written throughout this article, goes by many names. The Corneal Dystro- phies Foundation on its website describes the reasoning of the different names for the condition in which the cornea's basement membrane does not fully allow the overlying epithelium to adhere, causing everything from foreign body sensations to visual aber- rations to corneal erosions.