Eyeworld

EW REFRACTIVE 40 byline goes here plus fade February 2017 into account. We need to make the right choices and provide excellent postoperative care to ensure success- ful surgical results. Early recognition of keratoconus is very important, especially for future planning in young patients and for ruling out keratorefractive surgery in the future. Also, dry eye is a problem in refractive corneal surgery that we need to address. Managing compli- cated situations is essential and very important to realize in refractive surgery." EW References 1. Kohnen T, et al. Bewertung und Qualitätssi- cherung refraktiv-chirurgischer Eingriffe durch die Deutsche Ophthalmologische Gesellschaft und den Berufsverband der Augenärzte Deutschlands. Updated January 2014. Ophthalmologe. 2014;111:320–329. 2. Bühren J, et al. Wellenfrontaberrationen und subjektive optische Qualität nach wel- lenfront-geführter-LASIK: Erste Ergebnisse. Ophthalmologe. 2007;104:688–696. 3. Kohnen T, et al. Correction of moderate to high myopia with a foldable, angle-sup- ported phakic intraocular lens: results from a 5-year open-label trial. Ophthalmology. 2016;123:1027–35. 4. Ivarsen A, et al. Safety and complications of more than 1500 small-incision lenticule extraction procedures. Ophthalmology. 2014;121:822–28. Editors' note: Prof. Kohnen has no financial interest related to his comments. Contact information Kohnen: kohnen@em.uni-frankfurt.de complications persist, and at which time it is too late to perform an intrastromal retreatment. We have had young patients who fit all the criteria for this procedure and due to small, decentered optical zones were unsatisfied with their outcome," he said. Assessing the situation too quickly Refractive surgeons need to think on their feet, as there is no blueprint to how surgeries might turn out. Care- ful evaluation of any given operative situation will be the key to resolving unexpected turns in the surgical scenario. Prof. Kohnen discussed a case of a 68-year-old female pa- tient with cataract and astigmatism who decided on a multifocal lens implantation. Her topography was inconspicuous, and first eye cataract surgery using femtosecond laser and trifocal IOL implantation went well. After a few days, the second eye surgery followed and was set back by a posterior capsule rupture, which made implantation of the trifocal in this eye impossible. After discuss- ing options with the patient, Prof. Kohnen decided on a three-piece bifocal IOL. The post-surgical period was difficult necessitating optic capture, but eventually the situation was rectified and the correction completed in a satisfactory manner for the patient. Prof. Kohnen said, "Assessing the operative situation and resolv- ing problems is key. Preoperative, intraoperative, and postoperative measures always need to be taken Five continued from page 38 " Early recognition of keratoconus is very important, especially for future planning in young patients and for ruling out keratorefractive surgery in the future. Also, dry eye is a problem in refractive corneal surgery that we need to address. " –Thomas Kohnen, MD

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