Eyeworld

171 April 2016 EW MEETING REPORTER weeks of surgery but can sometimes be done later. For an IOL rotation, Dr. Rosman said this is indicated for the wrong IOL or wrong orientation postoperatively. This would ideally be done 6–12 weeks after surgery. Meanwhile, corneal laser refrac- tive surgery is indicated when an IOL rotation is not possible or when the residual astigmatism is not due to the IOL. Patients must fulfill cor- nea criteria for refractive surgery, he said, which means they must have a normal topography and sufficient corneal thickness. Finally, a surgeon may choose a secondary piggyback IOL when IOL rotation is not possible, if astigma- tism is not due to IOL orientation, or if corneal refractive surgery is not possible. Potential problems with this could be decentration, rotation, pigmentary glaucoma, or interlentic- ular deposits. In conclusion, Dr. Rosman said that post-cataract surgery astigmat- ic surprise can occur and is due to various factors. Surgical correction is possible, and different options are available, he said. Additionally, choice of surgery will depend on various factors, and surgery can re- sult in good refractive outcomes. Editors' note: Dr. Rosman has no related financial interests. IOL delivery systems, Dr. Vasavada said. Editors' note: The physicians have no related financial interests. Dealing with toric refractive surprises Despite a surgeon's best efforts, toric refractive surprises can still occur, said Mohamad Rosman, MD, Singapore. When this happens, it's important to determine the cause. This could include looking at the biometry to see if there was an error, looking for any IOL error, examin- ing any surgeon factors (like orien- tation of the IOL or SIA) that could have led to this problem, and seeing if there are any ocular or corneal factors. Sometimes it may seem like there is no potential cause, Dr. Rosman said. There are a number of treatment options to address these patients, including IOL exchange, IOL rota- tion, AK, laser refractive procedures, or piggyback lenses. Which option is best? Dr. Rosman said that factors to consider include the cause of the refractive surprise, the duration after cataract surgery, and the state of the cornea. When doing an IOL exchange, he said that the main indication is when the IOL choice is wrong. This would ideally be done within 6 A F R E S H P E R S P E C T I V E ™ © 2015 Lacrivera, a division of Stephens Instruments. All rights reserved. 2500 Sandersville Rd ■ Lexington KY 40511 USA lacrivera.com ( 855 ) 857-0518 William J. Faulkner, M.D. Cincinnati Eye Institute The VeraPlug ™ challenge results are in. Try the VeraPlug. ™ What will you say? "The VeraPlug ™ has become my punctal plug of choice. Design features allow easy sizing, quick insertion and longer stability. Both patient and doctor are pleased." continued on page 172 View videos from APAO 2016: EWrePlay.org Kyoko Ohno-Matsui, MD, discusses the benefits of using swept-source OCT imaging in pathologic myopia.

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