Eyeworld

EW FEATURE 57 TORIC/LRI MARKERS S9-2033 Pre-Operative Alignment Marker For marking patient on gurney or at slit lamp prior to procedure • Three fine marking points at 3, 6 and 9 for accurate reference • Properly angled handle allows an unimposing approach to patient S9-2060 Mendez Style Degree Gauge Intra-operative ring for aligning to steep axis and defining LRI points • Large 11.7mm internal diameter provides for maximum visualization • Beveled surface reduces reflections form microscope lighting • Crisp laser etched markings every 5˚ for greater marking accuracy S9-2065 Axis Marker Works inside the Degree Gauge to mark prime meridian (steep axis) for LRIs and Toric alignment. • Fits inside Degree Gauge perfectly • Crisp edges create a fine demarcation • Length of marks accommodates both limbal and corneal marking S9-2050 LRI Marker Provides crisp marks at commonly used LRI Positions • Fits inside Degree Gauge perfectly • Creates symmetrical, opposing marks for 30˚, 45˚ and 60˚ incisions • Fine arc connects degree endpoints for easy, acurate incisions 2500 Sandersville Rd., Lexington, KY 40511 USA Phone: 800-354-7848, 859-259-4924 Fax: 859-259-4926 E-Mail: sales@stephensinst.com www.stephensinst.com Visit Us at AAO Booth #3335 September 2014 Phaco and corneal comorbidities Other ocular surface abnormalities It is also important to be aware of other ocular surface abnormalities that a patient may have. Some of the most commonly missed, Dr. Hovanesian said, are anterior basement membrane dystrophy (ABMD) and endothelial guttae. He advised that all surgeons do- ing cataract surgery examine the cornea carefully. ABMD is a treatable condition, he said. If the irregularity causes staining or affects the central visual axis, try to intervene before- hand. Among the things that Dr. Ketcherside looks for are pterygium, ABMD, Salzmann's, and dry eye. He also checks for scarring. It's better in the long run if patients know ahead of time that some of these conditions can impact the final outcome, he said. Timeline The timeline for doing calculations and surgery after treating a patient's preoperative problems depends on the patient. Dr. Hovanesian said that for something like dry eye, there is usually a big improvement in just a couple of weeks. But if the surgeon is taking off the epithelium to treat epithelial basement membrane dystrophy, it could take a couple of months for the cornea to return to its most pristine condition with predictable refractive behavior. The general rule, Dr. Hovanesian said, is whatever intervention you do, make sure the eye returns to normal before you take the next step. Dr. Ketcherside agreed that the time between treating some of these issues and performing calculations and surgery depends on the patient. For mild dry eye that is treated with tears, he usually recommends about 2 weeks. If the condition is more serious, he may recommend the patient wait a month. Finally, when treating surface problems, Salzmann's, or pterygium, Dr. Ketcherside will usually wait 2 months for the patient to heal. Can cataract surgery worsen dry eye symptoms? Surgeons need to keep in mind that cataract surgery may worsen dry eye symptoms, although this is not always the case. Dr. Hovanesian said it is important not to scare patients away from surgery with unfounded fears, but he will have a discussion with patients to tell them how likely they are to encounter problems on a case-by-case basis. Dr. Ketcherside lets patients with dry eye know preoperatively that this could affect their cataract surgery. "I tell them that there shouldn't be a permanent lasting effect on their dry eyes from cataract surgery," he said, adding that there could be a mild increase in dry eye for several weeks to several months, but this usually goes away. By warning patients ahead of time, it helps relieve their anxiety, he said. Dr. Thompson said that it depends on the severity of the dry eye in deciding what type of preop- erative discussion is necessary with the patient. EW Editors' note: Dr. Hovanesian has financial interests with Allergan, Alcon (Fort Worth, Texas), and Bausch + Lomb. Drs. Ketcherside and Thompson have no financial interests related to their comments. Contact information Hovanesian: drhovanesian@harvardeye.com Ketcherside: cketch@gmail.com Thompson: cthom1@gmail.com The timeline for doing calculations and surgery after treating a patient's preoperative problems depends on the patient. … The general rule, Dr. Hovanesian said, is whatever intervention you do, make sure the eye returns to normal before you take the next step.

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