EyeWorld India June 2017 Issue

June 2017 46 EWAP cornea In these patients, Dr. Yeu said she typically schedules surgery for the first eye 6 weeks out and the second 8 weeks out, telling them they’ll return for repeat testing at Views from Asia-Pacific XIE Lixin, MD Professor, Shandong Eye Institute 5 Yan’erdao Road, Qingdao, Shandong, China Tel. no. +86(0)532-85897859 Fax no. +86(0)532-85897859 lixin_xie@hotmail.com T he prevalence of dry eye has been reported to be 5% to 34% worldwide, with generally higher rates among women and the elderly. Dry eye and cataracts are often comorbid conditions in an elderly patient. Cataract surgery has been shown to lead to development or worsening of dry eye symptoms, with dry eye being one of the most frequent complaints in the postoperative period. Development or worsening of dry eye symptoms after cataract surgery is multifactorial with corneal nerve transection, inflammation, goblet cell loss, and meibomian gland dysfunction (MGD) commonly cited as underlying disorders. In general, most patients can recover after a few months. The small percentage of patients who continue to have symptoms tend to have multiple preoperative risk factors. It is important to identify these susceptible patients prior to surgery. Patients with high-level risk factors for dry eye should be evaluated preoperatively to determine whether they have preexisting dry eye disease or if they are susceptible to developing disease after surgery. Identification of patients with dry eye preoperatively gives us the opportunity to optimize their ocular surface health and counsel them appropriately before proceeding with this elective procedure. As with any assessment, patient history and symptoms are important elements. High risk factors include older age, female sex, postmenopausal estrogen therapy, corneal refractive surgery, arthritis, dry mouth, complaint of eye dryness, watery eyes, burning, stinging, and foreign body sensation. The most common diagnostic tests utilized during the examination are staining, tear film breakup time, and Schirmer’s test. Slit lamp findings include debris in the tear film, low tear meniscus height, lid margin abnormalities, reduced meibomian gland expression, and conjunctival inflammation. The new dry eye diagnostic and treatment tool, the OCULUS Keratograph topographer (OCULUS Optikgeräte GmbH, Wetzlar, Germany), is faster and more accurate in diagnosing dry eye disorders, and is regularly used for patients before cataract surgery in our clinical practice. The device can help to assess the upper and lower eyelids for MGD, evaluate the tear film breakup, and automatically classify bulbar redness. In mild cases of dry eye, tear substitution will be sufficient; however, when patients complain about more severe or persistent discomfort, adjunctive therapy should be added based on the suspected underlying disorder. High-quality artificial tears are the first-line treatment for dry eye symptoms before cataract surgery, followed by preservative-free autoserum. For patients with moderate to severe dry eye disorder, there is likely an inflammatory component, even if it is subclinical. Cyclosporine A has become very popular as it is generally well tolerated and can be used for a long period of time. Small collagen or silicone plugs can be used to occlude the tear ducts in patients with severe aqueous tear deficiency. The LipiFlow Thermal Pulsation System has been shown to address the limitations of manual expression and warm lid compresses for obstructive MGD. It has obtained approved for clinical use in China. Biometry K values are more variable in patients with severe dry eye. To obtain the keratometry readings, I prefer a manual keratometer to an autokeratometer. For these patients, I usually recommend against advanced IOLs because of the poor postoperative vision quality. Intraoperative protection of the ocular surface and keeping the cornea moist are important. Shortening the time of cataract surgery and appropriate selection of surgical incisions are helpful. For patients with combined dry eye, the incisions are not recommended to be made at the temporal or nasal side. I am inclined to use a scleral tunnel incision during cataract surgery for severe dry eye cases. With continued advancements in preoperative diagnosis and treatment, we expect to see a reduction in the recovery time and severity of dry eye after cataract surgery. Editors’ note: Dr. Xie declared no relevant financial interests. Prepping – from page 45 continued on page 48 Double protection, double safety ! Tomography Biomechanics Now, measurable biomechanics – Corvis ® ST ! Twice as much information for twice as much safety in pre-op screening for keratorefractive surgery Enhance your practice with the world’s first tonometer capable of measuring and interpreting the biomechanical properties of the cornea. In combination with the tomography values from the OCULUS Pentacam ® , it gives you maximum safety and efficiency in refractive screening. OCULUS Corvis ® ST – take care of more patients with greater safety ! Want to learn more about corneal biomechanics? Check out www.corneal-biomechanics.de for more information, scientific material and lectures from the experts. OCULUS Asia Ltd. Hong Kong Tel. +852 2987 1050 • Fax +852 2987 1090 www.oculus.de • info@oculus.hk ASCRS Eyeworld Corvis Double Protection 123.4x247.7 e 08.16.indd 1 25.08.2016 19:50:11 3 to 4 weeks to see if surgery can proceed as scheduled. “In the meantime, I tell them, ‘I need to have a commitment from you that we’re going to use these