EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/880217
EW FEATURE 78 Challenging cataract cases • October 2017 by Vanessa Caceres EyeWorld Contributing Writer Ensure optimal corneal health before cataract surgery AT A GLANCE • Careful assessments can help determine how much treatment patients need for corneal disease before they have cataract surgery. • A variety of treatments are available for dry eye and lid margin disease; these problems are common in the cataract-age population. • In less severe cases of endothelial dysfunction, surgeons prefer to perform cataract surgery and endothelial surgery separately. • Generally speaking, FLACS does not provide much of an advantage when performed in combination with endothelial surgery. When needed, plan timing of endothelial surgery, cataract surgery depending on endothelial health E nsuring optimal health of the cornea before cataract surgery will help surgeons create the best possible outcome for patients. Seasoned cataract surgeons use a number of preop assessments and treatments to evaluate and improve corneal health—and sometimes, those treatments must extend post- operatively. The goal with the preop and postop treatments is to offer great quality of vision. One important starting point when assessing corneal health is the patient history, said Elizabeth Yeu, MD, Virginia Eye Consultants, Norfolk, Virginia. She will inquire about things like corneal pain upon awakening, recurrent erosions, and fluctuations in vision. She also likes to ask about glare symptoms at night. "Corneal guttata can lead to glare disproportionate to cataract," Dr. Yeu said. If she evaluates a pa- tient with early nuclear changes but significant guttata, she knows she will need to manage both the cornea and cataract. Assessment for ocular surface disease before cataract surgery is important, said Shahzad Mian, MD, Terry J. Bergstrom Collegiate Professor for Resident Education in Ophthalmology and Visual Sciences, continued on page 80 Very central epithelial basement membrane dystrophy (EBMD) that causes irregular astigmatism, which could be misinterpreted as ectasia, without the proper clinical exam and correlation; repeat topography and cataract surgery diagnostics were performed 6 weeks after the superficial keratectomy, which demonstrates much more regular astigmatism, with a drastically reduced magnitude and average keratometric value Source: Elizabeth Yeu, MD