EyeWorld India June 2015 Issue

52 EWAP REFRACTIVE June 2015 small as possible and is cognizant of hinge placement. “We know, for example, that a nasal hinge is a bit better than a superior hinge,” he said, adding that it is even more important to increase the width of the hinge and make them thin. In addition, he pointed out that a reverse side cut provides better nerve apposition. Dr. Trattler stressed the importance of being mindful not to induce a corneal abrasion intraoperatively. “Patients with dry eye who experience a corneal abrasion may require a few days for the abrasion to completely heal,” Dr. Trattler said. Postop treatment With prompt healing in mind in PRK cases, Dr. Donnenfeld moves aggressively postoperatively. “I want to optimize healing as quickly as possible, and non- healing PRK is a refractive emergency because it increases the risk of not only infection but also of haze,” he said. “Sometimes for a short time I’ll use amniotic grafts to promote healing,” Dr. Donnenfeld said. He also relies on medications postop. “We go with a transiently preserved tear using unit doses for the first 2 weeks,” he said. He gives the patient a regimen of tears every 3 hours. He will commonly continue Restasis on these patients for 3 months and sometimes will continue the steroids postoperatively as well. Dr. Devgan also emphasized the need for punctal plugs in these patients and the need to use preservative-free artificial tears. Some of the possibilities Dr. Devgan considers include Systane (Alcon, Fort Worth, Texas), Soothe (Bausch + Lomb, B+L, Bridgewater, NJ), Refresh (Allergan), and Optive (Allergan). For those with severe dry eye, he finds that typical tears may not be sufficient. “Sometimes you get to the point where you have to put in even thicker agents—some of these more viscous tears, gel- type tears, or even ointments,” Dr. Devgan said. Likewise, Dr. Trattler recommended the use of punctal plugs to maximize tear film quantity. His patients also receive a course of topical steroids. In addition, he said Restasis use is key because over time it increases tear production and goblet cell density. Overall, Dr. Donnenfeld finds that aggressive management of dry eye, especially the preoperative management and treatment, improves refractive results. “In my personal view, one of the hallmarks of a good refractive surgeon is the appropriate management of dry eye,” he said. EWAP Editors’ note: Dr. Devgan has financial interests with Alcon and B+L. Dr. Donnenfeld has financial interests with Allergan, Alcon, TearScience, TearLab, Rapid Pathogen Screening (RPS, Sarasota, Fla.), Abbott Medical Optics (Abbott Park, Ill.), and B+L. Dr. Trattler has financial interests with Abbott Medical Optics, Alcon, Allergan, B+L, and RPS. Contact information Devgan: Devgan@gmail.com Donnenfeld: ericdonnenfeld@gmail.com Trattler: wtrattler@gmail.com Buf ng - from page 51