Eyeworld

133 EW CORNEA October 2016 With a smaller incision, you may find that the incision is wa- tertight, and as with clear cornea cataract surgery, there can be high confidence that a sutureless incision is watertight, especially when small. Sutureless is more convenient to the patient, OR time and cost is less, and less astigmatism is induced. How- ever, the consequences of a leaky incision with DSAEK could be more severe than with cataract surgery. The tenth question was, "Do you prefer combined cataract + DSAEK or staged surgery?" Busin glide method and have found incision sizes can be very small, even 3.5 mm, without compromised graft function and results, and only one suture suffices. The ninth question was, "If the corneal incision is secure without a suture, do you still suture the corne- al incision?" Editors' note: Dr. Gossman is in private clinical practice at Eye Surgeons & Physicians, St. Cloud, Minnesota. He has no financial interests related to this article. Contact information Gossman: n1149x@gmail.com 840 Walnut Street Philadelphia, PA 19107 www.willseye.org 1-877-AT-WILLS What Wills Eye is saying about advances in cataract surgery. Watch lessons learned at the nation's busiest eye hospital. Visit willseyeonline.org to view these videos and more on current trends and treatment in ophthalmology. Knowledge Portal The Dense Lens Robert S. Bailey, Jr., MD IOL Options in the Absence of Posterior Capsule Support Irving Raber, MD Cataract Surgery in Special Situations Mark F. Pyfer, MD Pediatric Cataracts and Lens Disorders Caroline DeBenedictis, MD Complications of Phacoemulsification Sydney Tyson, MD Management of Uveal Prolapse and Cataracts Brad H. Feldman, MD Laser Assisted Cataract Surgery Douglas Wisner, MD IOL with Extended Range Mark Blecher, MD Knowledge Portal Knowledge Portal Knowledge Portal Knowledge Portal Knowledge Portal Knowledge Portal Knowledge Portal Yes 83% No 17% First cataract then DSAEK at a later date 61% Combined cataract + DSAEK 39% The final part of a comparison of our methods will be presented in an upcoming issue. EW Performing cataract surgery first then DSAEK at a later date has two main advantages. First, if cataract seems to be the primary cause of vision loss, it may be worthwhile trying cataract surgery alone, which is less invasive and without risk of rejection. A second advantage is that the anterior chamber may be more stable after the lens implant is more secure, making DSAEK easier. In terms of disadvantages of staged pro- cedures, two procedures rather than one results in added expense and inconvenience to the patient. In ad- dition, corneal edema after cataract surgery may be worse and disadvan- tageous for the DSAEK surgery.

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