Eyeworld

EW FEATURE 88 Intracorneal inlays • March 2016 The corneal inlay patient would most likely fall in the "dysfunction- al lens track," Dr. Waring said. "In addition to the clinical exam, this includes an advanced digital analysis of the cornea and crystalline lens with digital lens imaging and eval- uation of the optical scatter index to help us stage the dysfunctional lens," he said. "We can make a determination if they would be best served with a Endothelial Glide This unique instrument is used to atraumatically insert endothelial tissue. Its open design features a platform for tissue placement (endothelial side facing up) and a funnel-shape tapered tip which allows the surgeon to gently slide the tissue into position for the "pull-through" technique. Once the tissue is correctly seated, the instrument is inverted (endothelial side facing down) and the tip is placed at the edge of the primary incision. A special forceps is inserted through an opposing paracentesis incision and is used to grasp and pull the tissue into the anterior chamber. This retinal-style forceps has been specifically designed for use during Endothelial Keratoplasty procedures. The slightly curved 23-gauge shaft allows the instrument to be used through a paracentesis incision while its delicate end gripping platforms gently grasp the edge of the endothelial tissue to facilitate the "pull-through" technique. Endothelial Grasping Forceps Tissue on platform (endothelial side up) Gentle positioning toward tip Forceps grasps edge of tissue Tissue is "pulled through" into A/C Tissue in place (endothelial side down) Pull Through Technique Endothelial Inser tion Instrument s K5-7550 K3-4270 ® (973) 989-1600 • (800) 225-1195 • www.katena.com AD233-14A Managing continued from page 87 cornea procedure for presbyopia; if they have appreciable optical scatter then we would think about an intra- ocular procedure," Dr. Waring said. The corneal inlay would fall into the presbyopia algorithm path for stage 1 dysfunctional lens syndrome. Dr. Waring has experience working with the KAMRA (AcuFocus, Irvine, Calif.). Complications Dr. Whitman doesn't think compli- cations are common, but one thing to be aware of is the possibility of fibrosis or a foreign body reaction. Usually this can be treated by put- ting the patient on a topical steroid, but if the problem persists, the inlay may need to be removed. One other factor to be aware of is the presence of dry eye in patients. "Dry eye affects how good the vision is," Dr. Whitman said. This could affect near, intermedi- ate, and distance vision and could also have an impact on the corneal nerves. Dr. Whitman recommended observing good lid hygiene and be- ing sure that the patient has a good tear film early on. This is important to monitor both before and after surgery, he said. "There is always a risk for infec- tion, but we do not feel that the in- lay is an independent risk factor for infectious keratitis," Dr. Waring said. "Dry eye is also a potential risk with a cornea-based procedure, although the risk is extremely low and is not increased with an inlay." With new technology, like the AcuTarget HD (AcuFocus), there are objective dry eye diagnostics that help screen for patients with dry eye so physicians don't implant the inlay until the dry eye is adequately and properly controlled preop, Dr. Waring said. Decentration poses another po- tential problem. "But the inlays are relatively forgiving," he said. Again, Dr. Waring added that with ad- vanced diagnostics, surgeons can see where the inlay should be placed. Decreased contrast sensitivity offers a slight risk, with patients who might have difficulty reading in low light, but this is a known issue with all presbyopic procedures, he said. Dysphotopsias and irregular healing around the inlay also pose small risks. The benefit of the inlay is that it's easily removable, Dr. Waring said. Presenting the inlay to patients Although the KAMRA inlay is currently the only one approved in the U.S., there have been extensive studies around the world on differ- ent inlays. This helps show the good track record of the technology to patients. "The nice thing is you can say that thousands have been done elsewhere," Dr. Whitman said. He has been working with the Raindrop inlay (ReVision Optics, Lake Forest, Calif.) for about 5 years in trials. Results in patients implanted by Dr. Whitman with the Raindrop have shown that most can read J1 or J2. EW Editors' note: Dr. Waring has financial interests with AcuFocus. Dr. Whitman has financial interests with ReVision Optics. Contact information Waring: georgewaring@me.com Whitman: Jeffrey.Whitman@keywhitman.com

• Cover