EyeWorld Asia-Pacific December 2012 Issue

21 EWAP CATARACT/IOL December 2012 Treating ABMD in premium IOL patients by Vanessa Caceres EyeWorld Contributing Writer Cornea irregularities should be addressed pre-op P atients with anterior basement membrane dystrophy (ABMD) present with a number of corneal and visual challenges. However, if that patient is going to have cataract surgery and possibly a premium IOL implantation, treatment becomes even more challenging, said Bonnie An Henderson, MD , partner, Ophthalmic Consultants of Boston, and EyeWorld cataract editor. “One of my unhappiest patients was a woman with ABMD who underwent cataract surgery,” Dr. Henderson said. “The corneal findings were fairly mild and because she had other serious ocular comorbidities, I did not focus the discussion on the possible post- operative problems that could occur from ABMD but rather on her significant glaucoma and macular These images show a patient with ABMD who was told she would need a toric IOL. The images show her topography, her cornea, and lids. The patient had meibomitis and Demodex mites. The final images show her presentation after a superficial keratectomy. The patient was eventually happy with a Crystalens. Source: Steven G. Safran, MD disease.” The patient had uneventful cataract surgery but then had a good deal of pain at week 1 post-op due to epithelial loss. “Because I had not discussed the risks of ABMD and variable healing, she was very unhappy with her outcome and care even though her surgery went well and her final vision was 20/20,” Dr. Henderson said. By adding a premium IOL to the surgical mix, you set the bar higher in patients whose expectations are usually already high, said David D. Verdier, MD , Verdier Eye Center, Grand Rapids, Mich., USA. For this reason, careful pre-op diagnosis and treatment are crucial in patients with ABMD who want to have a premium IOL. Explaining the condition A patient who has anything but the mildest form of ABMD will require treatment before undergoing cataract surgery continued on page 22