EyeWorld India June 2017 Issue

52 EWAP cornea June 2017 Appropriate use of an amniotic membrane product in preoperative ocular surface optimization prior to refractive cataract surgery. Significant epithelial basement membrane dystrophy (EBMD) detrimental to accurate preoperative biometry and lens selection (top). A superficial keratectomy with placement of Prokera 3 days (middle) produced quality healing without haze or scar (bottom) allowing candidacy for and accurate selection of a presbyopia-correcting IOL. Source (all): Neel R. Desai, MD by Ellen Stodola EyeWorld Senior Staff Writer Tips to diagnose corneal lumps and bumps AT A GLANCE • Some cornea lumps and bumps may be left alone prior to cataract surgery if they are in the periphery and are otherwise not affecting vision. • A good slit lamp exam prior to cataract surgery is helpful; corneal topography is another useful tool. • If a surgeon removes something on the cornea, wait an adequate amount of time before doing IOL calculations to ensure the corneal surface has returned to normal. Physicians share some of their methods to diagnose and address corneal lumps and bumps prior to cataract surgery W hen performing cataract surgery, it’s important to diagnose and treat any other conditions prior to performing surgery to ensure the best outcome. Sumit “Sam” Garg, MD , vice chair of clinical ophthalmology and medical director, Gavin Herbert Eye Institute, Irvine, California, Lawrence Hirst, MD , the Australian Pterygium Centre, Brisbane, Australia, and Christopher Rapuano, MD , director of the cornea service, Wills Eye Hospital, Philadelphia, discussed some possible corneal lumps and bumps that patients may present with, when to treat these conditions, and what technologies they use. Best way to diagnose, treat “There’s no simple answer of how to diagnose lumps and bumps on the cornea,” Dr. Hirst said. “But the cornea has a limited range of conditions that occur on the surface.” Salzmann’s nodules, he said, are a common condition and degenerative change that can occur in older patients. Generally, these patients may be asymptomatic, he said, and the nodules often occur in the periphery. If they start to become more central and affect the vision, they can cause irregular astigmatism and visual distortion. If the Salzmann’s nodules are not in the central area, you don’t need to do anything with them, Dr. Hirst said. He recommends removal if the patient clearly has some visual changes that can be related directly to the Salzmann’s nodules. The simplest way to remove these is to strip them off the cornea, he said. Dr. Hirst also discussed epithelial basement membrane dystrophy (EBMD), which he said does not usually cause a discernable change in the surface contour of the eye in the deeper levels of the epithelium, but he said that occasionally it can be a precursor of erosive episodes on the surface of the eye and may cause some visual disturbance when in the visual axis. He added that phototherapeutic keratectomy (PTK) is an option for everything except for dysplastic conditions. However, he said that he finds that Salzmann’s nodules are easily removed by mechanical means. Dr. Garg said that he relies heavily on slit lamp exam, especially with the use of retroillumination. He added that topography and tomography are also vital. “Depending on the severity, I start with aggressive lubrication and offer superficial keratectomy [at the slit lamp],” he said. “I find that superficial keratectomy is generally effective at improving the ocular surface.” Dr. Rapuano stressed the importance of a good slit lamp exam. He added that corneal topography is also key, and you want to have a normal corneal topography map. It’s important to look at not just the colors on