Eyeworld

EW FEATURE 59 mannitol, I'll give digital pressure preoperatively for 5 minutes, I'll use reverse Trendelenburg—anything to lower the pressure." IOL considerations IOL power calculations are particu- larly challenging in these patients because of the potential for the cor- neal curvature to change over time. "Depending on the severity of the keratoconus, the calculations may tell you to put in a lens that doesn't exist," said Dr. Trattler. "So for advanced keratoconus, we dis- cuss with the patient that we are not able to eliminate all of the myopia with cataract surgery." If the non-surgical eye is nor- mal, one option for surgeons is to use that eye to determine the power calculation for the surgical eye, but it may not be entirely accurate, Dr. Weikert said. Lens implant choice is another issue that often arises in patients with diseased or transplanted corneas—especially the use of toric lenses. "Most eyes with corneal transplants do have some astig- matism, but you need to be very cautious about using a toric lens if you think there's a reasonable chance that they're going to need another transplant, at which point the astigmatism will change," said Dr. Rapuano. Dr. Trattler does not usually recommend toric lenses for patients with moderate to severe keratoco- nus, but does place them in patients with pellucid marginal degenera- tion, when the astigmatic axis is more regular. Dr. Weikert might con sider using a toric lens in very select cases if a patient has had crosslinking and he was reasonably sure that the cor- nea was strengthened and stable. He would feel more comfortable consid- ering it if the patient's vision can be signifi cantly improved with glasses. "That tells me that the astigmatism can be corrected with refraction and may respond well to correction with a toric lens," he said. Despite the challenges and long treatment process, patients can still achieve great visual results, Dr. Weikert said. "You take [patients] with cat- aract and corneal disease and step them through, and it may take a year or more to walk them through the process, but I've had them be some of my happiest patients," he said. EW Editors' note: Drs. Rapuano and Weikert have no fi nancial interests related to their comments. Dr. Trattler has fi nancial interests with Alcon (Fort Worth, Texas), Abbott Medical Optics (Santa Ana, Calif.), CXLO (Encinitas, Calif.), and LENSAR. September 2014 Phaco and corneal comorbidities Reference: 1. Data on file. LENSAR, Inc. The LENSAR Laser System – fs 3D (LLS-fs 3D) is intended for use in patients undergoing cataract surgery for removal of the crystalline lens. Intended uses in cataract surgery include anterior capsulotomy, laser phacofragmentation, and the creation of full and partial thickness single-plane and multi-plane arc cuts/incisions in the cornea, each of which may be performed either individually or consecutively during the same procedure. Laser Capsulotomy, laser phacofragmentation and/or corneal incisions surgery is contraindicated in patients: who are of pediatric age, whose pupils will not dilate or remain dilated to a diameter greater than that of the intended treatment and for capsulotomies and/or laser phacofragmentation with intended diameters of less than 4 mm or greater than 7 mm, who have existing corneal implants, who have previous corneal incisions that might provide a potential space into which the gas produced by the procedure can escape, who have conditions that would cause inadequate clearance between the intended capsulotomy cut and the corneal endothelium, such as: hypotony, uncontrolled glaucoma, who have corneal disease or pathology that precludes transmission of light at the laser wavelength or causes distortion of laser light, such as: corneal opacities, residual, recurrent, active ocular or uncontrolled eyelid disease or any corneal abnormalities (including endothelial dystrophy, guttata, recurrent corneal erosion, etc.) in the eye to be treated, ophthalmoscopic signs of keratoconus (or keratoconus suspect) in the eye to be treated, a history of severe dry eye that has not responded to therapy, a history of herpes zoster or herpes simplex keratitis. Potential contraindications are not limited to those included in the list. WARNING: The safety and effectiveness of this laser have NOT been established in patients with diabetic retinopathy, a history of treated glaucoma, or prior intraocular surgery. © 2014 LENSAR, Inc. All rights reserved. LENSAR and the LENSAR logo are registered trademarks and Augmented Reality is a trademark of LENSAR, Inc. 50-00078-000 Rev. A 08/14 The LENSAR ® Laser System can help you make all the right moves in femtosecond laser cataract surgery. That's because LENSAR was thoughtfully designed from the ground up to meet the needs of cataract surgeons, with unique features that increase workflow and procedural efficiencies, reduce CDE up to 100%, 1 and create a safe patient experience. And now with pending capabilities to connect with pre- and post-op diagnostics, LENSAR can help you further refine outcomes for increased accuracy and greater patient satisfaction. Learn more about LENSAR's winning combination at AAO, Booth 533. www.thinklensar.com THINK STRATEGIC femtosecond laser femtosecond laser cataract surgery. That's because LENSAR was thoughtfully designed from the ground up to cataract surgery. That's because LENSAR was thoughtfully designed from the ground up to features that increase workflow and features that increase workflow and and create a safe patient experience. and create a safe patient experience. to connect with pre- and post-op diagnostics, to connect with pre- and post-op diagnostics, Contact information Rapuano: cjrapuano@willseye.org Trattler: wtrattler@gmail.com Weikert: mweikert@bcm.tmc.edu

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