Eyeworld

EW CORNEA 68 February 2016 by Ellen Stodola EyeWorld Staff Writer She gave tips on what to consider and what questions to ask in these scenarios. We should always ask ourselves what we have to gain, she said. Is FLACS going to provide a better outcome? Dr. Donaldson said it's important to weigh the risks and benefits, and there may not be one universally correct answer that ap- plies to all patients. "We certainly don't want to add any risks," she said, and it's import- ant to first determine if there are any added risks of the procedure. Dr. Donaldson discussed some of the potential added risks for both the lens and the cornea. For the It's important to be aware of a patient's previous corneal surgery and corneal pathologies before using the femto laser D uring a session on femto- second laser-assisted cata- ract surgery (FLACS) at the 2015 American Acad- emy of Ophthalmology (AAO) annual meeting, Kendall Donaldson, MD, MS, Miami, pre- sented on "Femtosecond Cataract Surgery in Eyes with Previous Cor- neal Surgery or Corneal Pathology." Femtosecond laser use in eyes with corneal considerations Figure 1: Patient with prior LASIK. The cornea is clear, so this patient would be a good candidate for femtosecond laser use. Figure 2: Central corneal opacity due to prior hydrops in a keratoconus patient. This patient would not be a good candidate for femtosecond laser use. Figure 3: Large pterygium obscuring the visual axis and preventing adequate suction and obscuring laser penetration. This patient would not be a good candidate for femtosecond laser use. Figure 4: Small, flat pterygium allows adequate suction and is not obscuring laser penetration. This patient would be a good candidate for femtosecond laser use. Source: Kendall Donaldson, MD lens, there could be potential for an incomplete rhexis, leading to tags, anterior capsule tears, and/or pos- terior capsule tears. Dislocation of the nucleus into the vitreous could also be a problem. Meanwhile, for the cornea, perforation of LRIs are a potential problem because most imaging systems look at the center of the LRI only for corneal depth. There is also the unpredictable effect of LRIs and biomechanical destabili- zation of the cornea to consider. "Femtosecond cataract surgery requires a clear cornea," Dr. Donaldson said, so for this reason, it's important to identify poor candidates ahead of time. Corneal pathology and prior cornea surgery can potentially pose problems. Dr. Donaldson also recommended taking into account the density and location of any corneal opacities. Patients with prior cornea surgery include those who have had procedures such as radial keratot- omy (RK), LASIK, photorefractive keratectomy (PRK), Intacs, cross- linking, or a keratoplasty procedure. Mostly, you want to be sure that scars are not going to impact laser penetration, she said. Dr. Donaldson thinks patients who previously have continued on page 70

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