CORNEA 46 EWAP MARCH 2022 by Ellen Stodola Editorial Co-Director Looking for corneal disease prior to cataract surgery Contact information Hovanesian: jhovanesian@harvardeye.com Kim: terry.kim@duke.edu Rapuano: cjrapuano@willseye.org Schallhorn: jschallhorn@gmail.com It’s important for surgeons to be aware of preexisting corneal conditions that could have an impact on outcomes prior to cataract surgery. Several surgeons discussed some of the conditions to look for, tests to use, and how to treat before proceeding with cataract surgery. Common corneal conditions There are several common corneal disorders that can affect cataract surgery outcomes, said Julie Schallhorn, MD. Starting with the anterior corneal surface, significant epithelial abnormalities can impact keratometry and alter the plan for cataract surgery, she said. These conditions include epithelial basement membrane dystrophy (EBMD) and severe dry eye. Severe dry eye is usually easy to spot, Dr. Schallhorn said, but EBMD can be subtle. “Both of these can significantly impact keratometry and result in IOL calculation errors, which can sometimes be substantial,” she said. Salzmann’s nodules and pterygia are two other conditions that can significantly affect keratometry readings. “Pterygia are usually easy to spot, but sometimes even small ones can have a significant impact on keratometry,” Dr. Schallhorn said. “You should always correlate the clinical exam with topography in these cases and look for evidence of flattening in the area of the pterygium.” Salzmann’s nodules can be much more subtle, she said, but are important to diagnose and treat before cataract surgery. “Something that I am encountering more and more is patients who previously had LASIK or PRK but forgot that they ever had it,” Dr. Schallhorn said, adding that a LASIK flap can be detectable on exam, but patients who had PRK can have a completely normal corneal exam. For these patients, Dr. Schallhorn said looking at the topography is critical to detect the characteristic changes of prior ablation. There are less common things that can have an impact on cataract surgery as well, she said. These may include ectatic disorders, stromal keratitis, or corneal scars. “All of these are important to note and correlate with topography for surgical planning.” Additionally, Dr. Schallhorn said that an endothelial condition to recognize is Fuchs endothelial dystrophy. “Diagnosing Fuchs before surgery is important because this allows you to take extra precautions to protect the endothelium,” she said. “It is also important to alert the patient to this condition so that they know there is a risk of endothelial decompensation after surgery.” Christopher Rapuano, MD, said that dry eye and blepharitis are the primary corneal conditions to look out for This article originally appeared in the December 2021 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. This relatively small pterygium does not involve the visual axis but did cause some irregularity on corneal topography. Removal should be considered prior to cataract surgery.
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