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EW MEETING REPORTER 112 February 2017 topical steroids, Dr. Beckman will usually continue the current dose. He also said to consider punctal plug placement, an amniotic membrane graft, and encouraged use of fre- quent lubricants. For intraoperative consider- ations, the operative view is the primary concern, Dr. Beckman said. Protect the epithelium, consider try- pan blue, and be aware of floppy iris syndrome, Dr. Beckman said, adding hooks, rings, and other medications can manage the latter condition. Postoperatively, Dr. Beckman said he is very slow on tapering steroids. But he said to keep in mind that if the patient is already using chronic steroids, you should contin- ue at the preoperative level indefi- nitely rather than stopping. He discussed his plan for moving the patient off antivirals, noting that if the patient is already using chronic antivirals, he will also continue at the preoperative level indefinitely rather than stopping. Dr. Beckman mentioned using topical antibiotics and NSAIDs post- op. He encouraged surface-friendly compositions when possible and said to continue frequent lubricants. Editors' note: Dr. Greenwood has financial interests with Imprimis (San Diego). Dr. Beckman has financial in- terests with Allergan, Bausch + Lomb, accurate K readings by using multi- ple measurements. He also suggested checking old records dating back prior to infection, comparing to the other eye, and making a decision for keratoplasty. When you're deciding on kera- toplasty, Dr. Beckman said there are several factors to consider. First, is the view clear? If the view is clear enough, he will do cataract surgery alone and assess the vision poten- tial postoperatively. The patient could require a scleral lens postop- eratively, he said. If the view is not clear enough, he would consider a penetrating keratoplasty (PK) proce- dure alone vs. an open sky cataract surgery. However, if the view is clear enough but there is significant scar- ring, Dr. Beckman said to consider a standard PEIOL with subsequent PK at the same sitting. If PK is required due to a poor view and the cataract is minimal, you could do PK alone, according to Dr. Beckman. You may require 1 year or more until you're able to remove the cataract. Additionally, if PK is required and the cataract is signifi- cant, he said to perform a combined procedure. Dr. Beckman went on to discuss other preoperative treatments. "The medications are critical," he said. Dr. Beckman uses oral antivirals. If the patient is already using chronic light (IPL) treatment is an option, but it will push the cataract surgery by several months. Dr. Gupta tends to use thermal pulsation treatment because it gets the patient better a little faster. "You can only rehabil- itate what you have," she added, noting that this particular patient had lost many glands, which was also an important factor. Editors' note: Dr. Gupta has financial interests with Abbott Medical Optics, Alcon, Allergan, RPS, Shire, and TearScience. Refractive cataract and corneal surgery Michael Greenwood, MD, Fargo, South Dakota, spoke about sub- lingual sedation for cataract and refractive surgery. There are a range of sedation options, from nothing to general anesthesia. For sublingual sedation, liquids, troches, or oral pills are available. Dr. Greenwood started using sublingual sedation about a year and a half ago, and he said it has resulted in more relaxed patients, consistency, and a better ketamine stare where the patients focus in on the light. From the staff's perspective, they're easy to administer, Dr. Greenwood said. Less time is spent with IVs and there is less chance for delays. Dr. Greenwood's patient expe- rience with sublingual sedation has also been positive. Most are happy to avoid an IV and appreciate the quick onset and steady effect. It also allows for a pleasant second eye experience. Kenneth Beckman, MD, Columbus, Ohio, discussed some tips and pitfalls for cataract surgery with herpetic disease, highlighting preoperative, intraoperative, and postoperative considerations. Preoperatively, he mentioned treating active disease, remaining quiet for an extended period, man- aging the surface for accurate mea- surements, and assessing the impact of corneal scarring. If there is corneal scarring, Dr. Beckman stressed the need to obtain View videos from Hawaiian Eye 2017: EWrePlay.org Alice Epitropoulos, MD, discusses the current landscape as well as the pipeline for ocular surface disease management. Reporting from Hawaiian Eye 2017, January 14–20, Kauai, Hawaii Sponsored by

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