Eyeworld

EW FEATURE 48 Treating the cornea before cataract surgery • May 2017 AT A GLANCE • Some cornea lumps and bumps may be left alone prior to cataract surgery if they are in the periphery and are otherwise not affecting vision. • A good slit lamp exam prior to cataract surgery is helpful; corneal topography is another useful tool. • If a surgeon removes something on the cornea, wait an adequate amount of time before doing IOL calculations to ensure the corneal surface has returned to normal. by Ellen Stodola EyeWorld Senior Staff Writer keratectomy (at the slit lamp)," he said. "I find that superficial kera- tectomy is generally effective at improving the ocular surface." Dr. Rapuano stressed the im- portance of a good slit lamp exam. He added that corneal topography is also key, and you want to have a normal corneal topography map. It's important to look at not just the col- ors on the corneal topography map, he said, but also the rings. If you just look at the colors, this can blend in some of the abnormalities and may not show the whole picture. Each diagnosis will be treated somewhat differently, depending some visual disturbance when in the visual axis. He added that phototherapeu- tic keratectomy (PTK) is an option for everything except for dysplastic conditions. However, he said that he finds that Salzmann's nodules are easily removed by mechanical means. Dr. Garg said that he relies heavily on slit lamp exam, especially with the use of retro-illumination. He added that topography and to- mography are also vital. "Depending on the severity, I start with aggres- sive lubrication and offer superficial Physicians share some of their methods to diagnose and address corneal lumps and bumps prior to cataract surgery W hen performing cataract surgery, it's important to diagnose and treat any other conditions prior to performing surgery to ensure the best outcome. Sumit "Sam" Garg, MD, vice chair of clinical oph- thalmology and medical director, Gavin Herbert Eye Institute, Irvine, California, Lawrence Hirst, MD, the Australian Pterygium Centre, Brisbane, Australia, and Christo- pher Rapuano, MD, director of the cornea service, Wills Eye Hospital, Philadelphia, discussed some possi- ble corneal lumps and bumps that patients may present with, when to treat these conditions, and what technologies they use. Best way to diagnose, treat "There's no simple answer of how to diagnose lumps and bumps on the cornea," Dr. Hirst said. "But the cornea has a limited range of condi- tions that occur on the surface." Salzmann's nodules, he said, are a common condition and degenera- tive change that can occur in older patients. Generally, these patients may be asymptomatic, he said, and the nodules often occur in the pe- riphery. If they start to become more central and affect the vision, they can cause irregular astigmatism and visual distortion. If the Salzmann's nodules are not in the central area, you don't need to do anything with them, Dr. Hirst said. He recom- mends removal if the patient clearly has some visual changes that can be related directly to the Salzmann's nodules. The simplest way to re- move these is to strip them off the cornea, he said. Dr. Hirst also discussed epithe- lial basement membrane dystrophy (EBMD), which he said does not usually cause a discernable change in the surface contour of the eye in the deeper levels of the epithelium, but he said that occasionally it can be a precursor of erosive episodes on the surface of the eye and may cause Tips to diagnose corneal lumps and bumps A moderately large pterygium can be seen nasally in this right eye. An iron line (Stocker line) can be seen near the leading edge, indicating chronicity. Map and dot changes of epithelial basement membrane dystrophy (EBMD) are apparent centrally, which can cause irregular astigmatism.

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