EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78716
March 2012 Monday, February 20 Refractive enhancements post-cataract surgery Peripheral corneal relaxing incisions (PCRIs) done at the slit lamp are underutilized, as is the procedure in general, according to one surgeon speaking on the last day of the 2012 ASCRS Winter Update in Riviera Maya, Mexico. Using case presenta- tions, panelists took stances on the different ways to perform refractive enhancements after cataract surgery. Eric D. Donnenfeld, M.D., co-chair- man, Cornea, Nassau University Medical Center, East Meadow, N.Y., said PCRIs are easy to do right at the slit lamp, with patients sitting up. "If they are lying down, they think it's a surgery," he advised. "When they're sitting up, it's a procedure." "It's a very simple way to treat post-op astigmatism," said Jonathan B. Rubenstein, M.D., vice chairman and Deutsch Family Professor of Ophthalmology, Rush University Medical Center, Chicago. Dr. Rubenstein said he doesn't like to do the incisions at the slit lamp because he worries that the patient will move his or her head.Dr. Donnenfeld offered a pearl to cut down on corneal abrasions. "Put vis- coelastic on the eye or Blink Tears [Abbott Medical Optics, AMO, Santa Ana, Calif.] if you're doing them at the slit lamp," he said. "It allows the incision to glide over the cornea and cuts down on your abrasions." Stephen S. Lane, M.D., clinical pro- fessor of ophthalmology, University of Minnesota, Minneapolis, argued in favor of LASIK/photorefractive keratectomy (PRK) enhancements. PRK has advantages over LASIK, he said, especially for patients with ab- normal topographies "PRK, in my mind, is the way to get residual re- fractive error if you can't get it from a simple incisional technique," Dr. Lane said. Despite all of the advan- tages, PRK isn't perfect because it's slow and often comes with a painful recovery. Patients may also experi- ence haze, he said. Clara C. Chan, M.D., University of Toronto, argued for piggyback IOLs, stating that some surgeons even use the tech- nique, while controversial, for the treatment of negative dysphotopsias after routine cataract surgery with in-the-bag IOL placement. Dr. Donnenfeld said an advantage of IOL exchange is that it is a covered procedure and laser enhancements are not. "If I have a refractive insta- bility and am off a significant amount, I will go back as soon as a week and exchange my lens," he said. Eliminating eye drops In a change of pace for the meeting, Dr. Donnenfeld invited attendee Jeffrey T. Liegner, M.D., Sparta, N.J., to give a presentation about how he has all but eliminated the need for eye drops before and after cataract surgery. Showing video, Dr. continued on page 130