EyeWorld Asia-Pacific September 2014 Issue

13 September 2014 EWAP FEATURE Alcohol-assisted PRK clinical.ewreplay.org/?v=36 42407256001 Transepithelial PRK clinical.ewreplay.org/?v=36 42392321001 Watch these videos on your smartphone or tablet using your QR code reader. (Scanner available for free at your app store.) Laser treatment of residual refractive error Laser treatment of residual refractive error Source (all): Karl Stonecipher, MD Views from Asia-Pacific Hungwon TCHAH, MD Opthalmology, Asan Medical Center, University of Ulsan, 388-1 Pungnab-dong Songpa-gu, Seoul, KOREA Tel. no. +82 230103680 Fax no. +82 2 4706440 hwtchah@amc.seoul.kr I s residual refractive error after cataract surgery a common complication? Most patients who undergo cataract surgery expect his or her best visual acuity to be regained with the naked eye, but residual refractive error makes all the results unsatisfactory. There are several options for managing residual refractive errors. First, spectacles are the easiest and safety way if the patient agrees to wear them. IOL exchange with LRI can be a good option if there is a relatively large residual refractive error. However, these procedures must be done within 2–3 months after first cataract surgery. After 3 months, the elimination of the IOL can be challenging since stability between the epithelial cells and posterior capsule has been achieved. In my case, if prompt results show over 1.5 D of refractive error, the IOL exchange procedure is done in no time. If the range of refractive error is within reasonable range, then the change of refraction is closely observed and the refractive procedure performed after 2 months if needed. The LASIK procedure produces less pain and more immediate—in fact instant— good visual outcomes compared with the PRK procedure. Moreover, these post- cataract patients have small residual refractions to treat, so the complication rate after LASIK procedure can be reduced. However, for a cataract surgeon who is not familiar with the LASIK procedure, surface ablation is very effective in treating residual refractive error as well. It has a minimal learning curve and long-term results are almost the same as those of LASIK, as Dr. Devgan mentioned. However, visual recovery after surface ablation takes longer than with LASIK, which can be a difficult situation for an already dissatisfied patient, especially in the case of a premium IOL patient. So I personally prefer the LASIK procedure, with very good results. Recently, I performed astigmatism keratotomy with the femtosecond laser and the results were good. I included patients who had residual astigmatism of 1.0 D to 2.0 D and with reasonable spherical equivalent after cataract surgery, and the results showed significant effectiveness. Surgeons in training could try femtosecond AK without being intimidated because of its short learning curve. In every procedure, I always emphasize dry eye treatment. Cataract surgery itself can induce dry eye, and adding the refractive procedure could add a much higher risk of dry eye. Dry eye after these procedures can lead to bad outcomes. Therefore, the management of dry eye should be always kept in mind. Editors’ note: Prof. Tchah has no financial interests related to his comments.