Eyeworld

EW CATARACT 25 August 2016 Dr. Miller also took pressure into account with this RK patient's eye during surgery. "If you put too much pressure in the eye, you can cause the RK incisions to buckle, and the patient will go through the whole healing process that he went through for the first two months after RK again," he said. Overall, the surgery went well, and the patient was 20/80 –1 +2 with some of the expected corneal swelling at one day postop. Two weeks postop, the patient was 20/25 –2, but he had a significant amount of vertical astigmatism, which Dr. Miller said was the result of the cautery. His spherical equivalent refractive error was +1. The patient will be back in about a month, and most of his cau- tery-induced astigmatism should be gone by then, Dr. Miller said. "It will be interesting to measure his spherical refractive error when he returns," he said. The hypero- pia may resolve as his RK incisions recover, and he may end up with ex- cellent uncorrected vision. If it does not, Dr. Miller will discuss options including PRK, a lens exchange, or piggyback IOL implantation, depending on the amount and direc- tion of the error and the presence of concomitant astigmatism. Mark Packer, MD, president, Mark Packer MD Consulting, Boul- der, Colorado, said Dr. Miller's deci- sions in this case seem reasonable. He added, however, that he might have used a bimanual microincision approach, going between the RK incisions. "Other than that, I probably would have done everything the same," Dr. Packer said. If a touch-up is needed, Dr. Packer said he would use a piggy- back IOL for uncorrected sphere, whereas if there is both uncorrected sphere and cylinder, he'd recom- mend PRK with mitomycin-C. EW References 1. Manning S, et al. Cataract surgery out- comes in corneal refractive surgery eyes: Study from the European Registry of Quality Outcomes for Cataract and Refractive Surgery. J Cataract Refract Surg. 2015;41:2358–65. 2. Amesbury EC, et al. Functional visual outcomes of cataract surgery in patients with 20/20 or better preoperative visual acuity. J Cataract Refract Surg. 2009;35:1505–08. Editors' note: Drs. Miller and Packer have no financial interests related to their comments. Contact information Miller: miller@jsei.ucla.edu Packer: mark@markpackerconsulting.com Beaver-Visitec International, Sales Limited 85c Park Drive, Milton Park, Abingdon, Oxfordshire, OX14 4RY, UK Tel: 44.1865.601.256 Fax: 44.1865.595.761 www.beaver-visitec.com Accept an invitation to our clinical wet lab Endo Optiks® ECP and Retinal Endoscopy Surgical Course & Wet Lab Date & Time: Saturday, September 10th at 6:00 pm Location: Bella Sky Hotel, Room: 181 (adjacent to Bella Congress Center) Refreshments will be served Register: Booth CN56 or www.endooptiks.com Receive: Course certifi cate upon completion of hands-on-wet lab BVI, BVI Logo and all other trademarks are property of Beaver-Visitec International (BVI) © 2016 BVI Booth CN56 Join Beaver-Visitec at ESCRS for an exciting endoscopy course with hands-on wet lab Saturday, September 10th at 6:00 pm (adjacent to Bella Congress Center) Booth CN56 or www.endooptiks.com Course certifi cate upon completion

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