Eyeworld

EW CATARACT 44 November 2017 Research highlight by Maxine Lipner EyeWorld Senior Contributing Writer group. "However, in the group with the suture there was no dehiscence of the RK incision during cata- ract surgery," he said, adding that patients in group 3 fared better in another respect as well, with statisti- cally lower additional postoperative astigmatism. With that in mind, Dr. Kaufman advised that in cases of 16-incision RK, practitioners prepare according- ly. "If the patient has four or eight RK incisions, it is possible to avoid the RK incision," he said, adding that with 16 this is virtually impossi- ble. In such cases, he recommended preplacing a suture at the begin- ning of the cataract surgery before the clear corneal incision or even before the paracentesis is performed to enhance safety. "The only other option is to do a scleral tunnel type of incision to avoid the RK incision, but that can make the surgery more difficult," Dr. Kaufman said. "I think the method using the suture with the clear corneal incision would be the preferred method for the majori- ty of cases." In addition, it is wise to decrease the infusion rates and to watch all of the RK incisions, not just those adjacent to or near the clear corneal incision since any of these can open up. When dealing with post-RK cataract patients, Dr. Kaufman urged practitioners to remind patients that IOL calculations may be inaccurate and that if they've had diurnal vari- ations in their refraction previously, it's likely this will remain an issue even after cataract surgery. "I would not recommend putting a multifocal lens in these patients," he said. Overall, Dr. Kaufman hopes that practitioners come away from the study understanding the importance of a stabilizing suture to decrease the risk of dehiscence as well as the oc- currence of additional postoperative astigmatism. EW Reference 1. Meduri A, et al. Cataract surgery on post radial keratotomy patients. Int J Ophthalmol. 2017;10:1168–1170. Editors' note: Dr. Kaufman has no financial interests related to his comments. Contact information Kaufman: 646-682-9192 corneal incision without intersect- ing one of the RK incisions, Dr. Kaufman explained, adding that if it had been a four-incision or eight-incision RK it might have been a different story. In the study, group 1 included patients with a cataract incision placed superiorly, while in group 2 this was placed temporally, Dr. Kaufman noted, adding that in group 3 the incision was likewise temporal but with a 10-0 nylon suture placed across the RK incision adjacent to the primary cataract surgery incision to keep it closed. "That decreased the chance that the RK incision would splay open or dehisce during the cataract surgery," Dr. Kaufman said. "That suture was kept in for 2 weeks after cataract surgery and then removed." During cataract surgery the infusion and as- piration rates as well as phaco power were decreased as a precautionary measure. "If the infusion is too high, sometimes that will increase the intraocular pressure, and that can cause the RK incisions to open during surgery," he said. Investigators determined that in the first two groups dehiscence occurred, with instances in three out of eight patients in the first group and two out of eight in the second and started in the Detroit area," Dr. Kaufman said. RK is still being performed in some areas of the world. Dr. Kaufman pointed out that much of the research from the study was conducted in Italy by the lead au- thor Alessandro Meduri, MD, with many of the RKs quite recent. "Some of these patients had RK within the last 10 years," he said. "It is a surgery that works." There is more than one type of RK, he said, adding that includes old-style RK as well as a newer type called mini-RK, which is more stable. Cost is one reason this contin- ues in some areas. "You don't need a $500,000 laser, and it works," Dr. Kaufman said. "In different regions of the world, RK has been performed more recently than it has in the U.S." Studying incision placement The study included 18 patients who had undergone RK in Italy, and 24 eyes were included in total. "They divided those 24 eyes into three groups with eight eyes in each group," Dr. Kaufman said. All of those included had undergone 16- cut RK, which complicated things for the cataract surgeons. In such cases, it's impossible to make a clear Recent study explores how such previous surgery may impact a current cataract procedure F rom time to time, prac- titioners in the U.S. may find themselves faced with patients who have previous- ly undergone radial keratot- omy (RK). How does such previous surgery impact a current cataract procedure? In a study 1 published in the International Journal of Ophthal- mology, investigators determined that taking an extra step to stabi- lize RK incisions can help protect against dehiscence and astigmatism, according to Stephen Kaufman, MD, professor and vice chairman of ophthalmology, director of cornea and refractive surgery, State Univer- sity of New York Downstate Medical Center, New York. Aging RK contingent RK continues to crop up among some cataract patients. "The num- ber of patients that we see is quite regional because RK, which was brought to the U.S. in the late 1970s, has been present for some time Helping prior RK patients with cataract surgery A post-RK compromised cornea Source: Mark Packer, MD

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