Eyeworld

EW CATARACT 88 April 2016 that she donated 2 Crystalens IOLs to a needy patient who could not afford these lenses. Summary There are several take-home messag- es from this case. It is imperative to clean up the ocular surface prior to cataract surgery. Not only is this crit- ical for infection prevention, but it is also necessary to allow for adequate preoperative corneal measurements and IOL selection. In addition, a healthy surface is necessary to avoid postoperative visual aberra- tions, which are often the source of an unhappy patient despite an uncomplicated surgery. This treat- ment needs to be continued even af- ter the surgery has been completed. Often, these patients have other comorbidities, such as glau- coma. The treatment of those other conditions may contribute to the complications of the dry eye disease and need to be addressed as well. In this case, the patient was treated with preservative-free drops initially and then with selective laser trabec- uloplasty to eliminate the need for glaucoma drops altogether. With careful attention to the ocular sur- face prior to cataract surgery, even presbyopic IOLs can be used success- fully. Caution should be taken with the use of multifocal IOLs for these patients. Finally, for patients who do not respond to traditional dry eye ther- apy or those who complain of other systemic symptoms such as dry mouth, look for other underlying causes, such as Sjogren's syndrome. Diagnostic testing is available, and early diagnosis may lead to better outcomes. EW Editors' note: Dr. Beckman is director of corneal services, Comprehensive EyeCare of Central Ohio, Westerville, Ohio, and clinical assistant professor of ophthalmology, The Ohio State University, Columbus. He has finan- cial interests with Bausch + Lomb and Allergan (Dublin). Contact information Beckman: kenbeckman22@aol.com by Kenneth Beckman, MD, FACS From a dry eye standpoint, she had been using cyclosporine drops but was developing intoler- ance to these. She was also using preservative-free artificial tears. Being that she was complaining of dry mouth, she underwent Sjo testing (Bausch + Lomb, Bridge- water, N.J.). The Sjo test is a blood test for Sjogren's syndrome with new biomarkers able to detect early Sjogren's syndrome. Despite nega- tive results for traditional biomark- ers of Sjogren's syndrome (RF, ANA, SS-A, and SS-B), she was found to have positive salivary protein 1 IgG antibodies. This was consistent with early Sjogren's syndrome. She was then referred to a rheumatologist for systemic management. Gradually, her dry eyes improved and she was able to undergo cataract surgery. The patient underwent successful cataract surgery OU with Crystalens (Bausch + Lomb) placement. Postop, she was so pleased with her results from surgery and from her dry eye management Case report A 63-year-old female came to my office presenting with cataracts and dry eyes. Upon examination, she was found to have significant cata- racts as well as elevated intraocular pressure and severe dry eyes. While she was anxious to proceed with sur- gery, she needed to first have her dry eyes and elevated pressure treated. Due to her asthma, beta block- er drops were avoided. She had difficulty tolerating brimonidine and eventually was started on preservative-free Zioptan drops (tafluprost, Akorn, Lake Forest, Ill.) as I was concerned about the effects of glaucoma drops on her ocular surface. Her pressure improved but she was beginning to have diffi- culty even tolerating the Zioptan. She later underwent selective laser trabeculoplasty and finally was able to achieve adequate pressure control, while sparing her the added toxicity of multiple glaucoma drops. Eventually, even the Zioptan was discontinued. Dr. Beckman shares a case study of a patient with a complicated preop path T here has been significant discussion recently about managing the ocular surface prior to cataract surgery. Unfortunately, this can be a long process, and it may take weeks to months before the surface is optimized for surgery. Patients are eager to proceed with cataract surgery quickly and may be- come frustrated with a long preop- erative course preparing for surgery. Yet it is essential to optimize the surface prior to proceeding to obtain the best results. This article de- scribes a case of a patient with severe ocular surface disease and cataracts, demonstrating the complex preoper- ative course prior to proceeding with cataract surgery. Managing the ocular surface for cataract surgery with presbyopic IOLs Diffuse corneal staining with filaments in severe dry eye patient Source: Kenneth Beckman, MD, FACS

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