EyeWorld Asia-Pacific March 2016 Issue

40 EWAP Cataract/IOL March 2016 Dry eye with corneal epithelial epithelial defects Fuchs’ dystrophy, with obvious extensive endothelial cell loss in the pupil zone. This patient is expected to have a more challenging postoperative course. This pterygium looks as if it is only affecting the peripheral cornea, but is actually causing irregular corneal astigmatism. It must be surgically removed and the ocular surface given time to heal before the patient can undergo cataract surgery. Source (all): Uday Devgan, MD by Michelle Dalton EyeWorld Contributing Writer Cataract surgery in eyes with compromised corneas For patients with an unhealthy cornea, cataract surgery options are more limited T here are numerous causes behind an unhealthy cornea— Fuchs’ dystrophy and dry eye, among others—but couple the corneal disease with visually significant cataract, and patients’ options are more limited than if the cornea had been healthy. Even after treating the corneal problem, these patients often do not achieve the level of visual recovery that people without corneal disorders do. Experts say be cautious with these patients, and expect to spend more time with them. “A basic rule of thumb, with few exceptions, is that if the patient has a significantly compromised cornea, don’t consider multifocals,” said Marguerite B. McDonald, MD , Ophthalmic Consultants of Long Island, because to truly appreciate the benefit of a multifocal lens, the eye has to have “exquisitely perfect optics.” Younger patients with very mild dry eye that can be medically controlled may be an exception, but those with even the mildest form of Fuchs’ today are probably going to need corneal surgery down the road, and Dr. McDonald would argue against a multifocal lens. Patients with any type of corneal dystrophy or abnormality should be considered for a pseudoaccommodating lens rather than multifocal IOLs because of “the additional issues of contrast sensitivity diminution, which are caused by the multifocal. Even if a superficial keratectomy is performed for epithelial basement membrane dystrophy (EBMD), there is a significant percentage of patients in whom this condition recurs,” said Steven M. Silverstein , MD , founder, Silverstein Eye Centers, Kansas City, Mo. Vance Thompson, MD , founder, Vance Thompson Vision, Sioux Falls, SD, thinks the issue may not be so clear-cut. “First analyze if it is an anterior, central, or posterior corneal issue. Can it be easily addressed with corneal scraping or a PTK? If we can take that irregularity or multifocality and remove it to make more of a monofocal cornea or an acceptable amount of multifocality, then I might consider a multifocal lens.” However, if the RMS value cannot be dropped to under 0.2, “then you don’t want to add additional multifocality to the eye, and I would consider a Crystalens [Bausch + Lomb, Bridgewater, NJ] because its optic is an aspheric monofocal.” Multifocal lenses “will amplify any abnormalities of the cornea,” said Uday Devgan, MD , founder, Devgan Eye Surgery, Los Angeles, chief of ophthalmology, Olive View-University of California Los Angeles (UCLA), and clinical professor of ophthalmology, UCLA. “I think multifocal lenses should always be used with caution, even with perfectly normal eyes, but you should be very careful of an