EyeWorld Asia-Pacific December 2015 Issue

27 December 2015 EWAP FEATURE Mastering cataract surgery with ocular comorbidities by Lauren Lipuma EyeWorld Staff Writer AT A GLANCE • Optimize the ocular surface before proceeding with surgery. • With the eye open and access to the angle, cataract surgery is an opportunity to treat glaucoma, and surgeons should take advantage of it. • Avoid multifocal IOLs in patients with persistent dry eye or glaucoma. • Identify risk factors for AMD progression before surgery and communicate those risks to the patient. In a patient with glaucoma who is undergoing cataract surgery, surgeons may want to consider doing ECP or an ab interno procedure at the time of the cataract surgery. Source: National Eye Institute How best to remove cataracts while managing dry eye, glaucoma or macular degeneration C ataract surgeons now have the tools and techniques to offer their patients better visual outcomes after surgery than ever before. But with more individuals suffering from glaucoma, dry eye, and age-related macular degeneration (AMD), caring for cataract patients—before, during, and after surgery—becomes far more complex. The presence of dry eye, glaucoma, or AMD increases the risk of complications, but with proper planning and technique, cataract surgeons can achieve good visual outcomes even with these comorbidities. Here, four leading ophthalmologists share pearls for managing cataracts in the presence of these coexisting diseases. Dry eye and glaucoma Optimize the ocular surface before proceeding with surgery. Dry eye is likely to get worse after cataract surgery, so optimize the ocular surface prior to operating and continue treatment after surgery, said Preeya Gupta, MD, assistant professor of ophthalmology, Duke Eye Center, Durham, NC. Address meibomian gland dysfunction (MGD) as soon as possible with treatments such as thermal pulsation or omega-3 supplements. Treat any ocular surface inflammation with topical cyclosporine and/or steroids, she added. Be aware of the total preservative load you’re placing on the ocular surface. Topical medications can be toxic to corneal epithelial cells, so be aware of the total preservative load, especially when using generics, Dr. Gupta said. For patients with corneal staining postop, consider switching to preservative-free medications or altering the dosage. “I often discontinue the NSAID or lower the dosage, as this class of drugs can be epitheliotoxic in some patients,” she said. Recognize that cataract surgery is an opportunity—and don’t waste it. With the eye open, continued on page 28