Eyeworld

Step by step: Clinical and practical implementation of laser-assisted cataract surgery 6 by William B. Trattler, MD Beyond the laser raphy revealed early keratoconus, which will reduce her quality of vision postoperatively (Figure 1). Preoperative assessment I recommend corneal topography for all cataract surgery candidates to determine whether they have a corneal condition that could affect postoperative vision. Many experts estimate a kera- toconus incidence of approximate- ly 1 in 2,000 in the United States. 1 I believe it is much more common in our cataract surgery population. When we studied 400 consecutive eyes scheduled for cataract surgery, approximately 30% had abnormal preoperative topography. Excluding eyes that had previous RK or LASIK, approx- imately 25% still had abnormal topography. Three percent had keratoconus. Abnormal corneal topography in the presence of a Surgeons need to consider the ocular surface, residual refractive error, and other factors to deliver optimal results with laser-assisted cataract surgery P atients receiving femto- second laser-assisted cat- aract surgery (LACS) have high expectations regard- ing their visual recovery. To provide the outcomes patients desire, surgeons need to perform a careful preoperative examination and take steps to minimize corneal swelling, avoid cystoid macular edema, and prevent ocular surface disease after surgery. Case report A 68-year-old cataract patient had a best corrected visual acuity of 20/50 before surgery. The optical coherence tomography (OCT) scan of the macula appeared healthy, and the cornea was crystal clear, with no guttata. She had a 2+ NS cataract. While she appeared to be a good candidate for cataract surgery, performing preoperative topography was important in this case to properly set expectations for the anticipated visual result. This is because the corneal topog- William B. Trattler, MD continued on page 7 normal-appearing slit lamp exam appears common in patients scheduled for cataract surgery, so it is useful to identify any corneal shape changes before surgery. We also need to detect and treat dry eye and blepharitis preoperatively, which can lead to incorrect intraocular lens (IOL) power calculations and affect Figure 1. A 68-year-old woman was found to have forme fruste keratoconus. " I recommend corneal topography for all cataract surgery candidates to determine whether they have a corneal condition that could affect postoperative vision. " –William B. Trattler, MD

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