EyeWorld Asia-Pacific June 2021 Issue

CATARACT 26 EWAP JUNE 2021 ask to see these patients preoperatively (assuming that an OCT has been obtained by the cataract surgeon) or postoperatively unless they are experiencing visual symptoms. However, in patients with a recent history of or active DME, she likes to see them in the perioperative period to ensure that their retinal status is optimized before they go to the OR and that they do not require retinal treatment afterward. She recommends obtaining an OCT for all patients prior to cataract surgery. According to Dr. Devgan, patients who have their diabetes under control and who have minimal background diabetic retinopathy without macular lesions tend to do very well with cataract surgery. “However, patients who have significant diabetic retinal disease, such as macular edema or proliferative vasculopathy, should be treated by a retinal colleague prior to cataract surgery,” he said. “ If the patient has a cataract that is bad enough to impair visualization of the retina, our retinal colleagues will have us perform the cataract surgery first, and they may also premedicate with an intravitreal injection first.” Dr. Charles also stressed that cataract surgery does not make DME worse, noting that he thinks inflammatory CME was likely misinterpreted as DME using OCT thickness data in studies that suggest that cataract surgery does increase DME. He also said that OCT is necessary before every cataract surgery. Cataract surgery in dry AMD and wet AMD When choosing an IOL for patients with AMD, Dr. Charles said not to use multifocal or EDOF IOLs. Multifocal IOLs can decrease contrast sensitivity and generally should be avoided in patients with macular disease, he said. In terms of considerations for timing of the surgery with intravitreal injections, Dr. Charles said not to alter the injection cycle or interval. Cataract surgery must be performed in the middle of the injection interval (not the same day or immediately pre- or postop), he said. Dr. Weng advised hydrophobic acrylic monofocal IOLs as the safest choice for patients with wet or dry AMD. “Presbyopia-correcting IOLs should be used with caution because of possible degradation in contrast vision and an approximately 15% loss of light from diffractive optics,” she said. “It may be beneficial to aim for distance vision so that the plus spectacles used for reading provide an added magnification boost.” Dr. Weng added that she does not routinely bring a patient in for a dedicated preop retinal check, assuming dry AMD patients are already being regularly followed and that wet AMD patients are on an established treatment regimen. “However, this again assumes that the cataract surgeon is obtaining a preoperative OCT in all patients to confirm no changes from baseline,” she added. “If not, I am always happy to see the patient beforehand.” She said it’s important to remind AMD patients that their surgical outcomes may not match those of their friends and neighbors without retinal disease. “Assessing patients’ visual potential through examination and imaging is critical in this cohort so that their expectations can be properly set.” In terms of timing of surgery with any intravitreal injections, Dr. Weng said that she tries not to disrupt the schedule of intravitreal injections in wet AMD patients, although she prefers not to inject on the first postoperative day. “Timing the surgery so it falls between injections is ideal if possible,” she said. When handling a patient with AMD, Dr. Devgan said he will coordinate care with retinal colleagues, and for most of these patients, the best choice is a monofocal IOL and a goal of plano spherical equivalent. “We explain to the patient that the eye is like a camera; with cataract surgery, we are changing to a new and improved lens, but the film of the camera, the retina, is still affected by the macular degeneration,” he said. “If the retina doctor deems that an intravitreal injection is needed prior to the cataract surgery, we will certainly heed that advice.” Cataract surgery after pars plana vitrectomy or intravitreal injections When performing cataract surgery after a pars plana