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Resolve corneal irregularities before performing cataract surgery
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CHICAGO – Visually significant corneal disease should be addressed before planning cataract surgery in eyes with these comorbities, a speaker said here.
“Before recommending cataract surgery, identify surface problems for visual disturbances, like Salzmann’s nodular dystrophy, epithelial basement membrane disease and pterygia,” Samar K. Basak, MD, said during Corneal Subspecialty Day preceding the American Society of Cataract and Refractive Surgery annual meeting. “Otherwise, there may me sub-optimal visual outcomes.”
Salzmann’s nodular dystrophy, epithelial basement membrane disease and pterygium cause regular and irregular astigmatism, and various corneal aberrations, Dr. Basak said.
Treatment options for epithelial basement membrane disease include epithelial debridement and phototherapeutic keratectomy, which is expensive and has a higher recurrence rate than other treatments, Dr. Basak said.
Corneal topography is essential in identifying small pterygia with induced astigmatism of less than 1 D, he said.
“Slit lamp photography and topography are very useful tools to counsel the patients,” Dr. Basak said. “Then appropriately set their expectations.”
Cataract or pterygium surgery may be performed first and the other procedure done later. Both procedures may also be done simultaneously, he said.
Cataract surgery alone is recommended in eyes with small pterygia that do not affect keratometry readings, small avascular pterygia with no cosmetic impact or pterygia with an advanced cataract that cannot wait for surgery, Dr. Basak said.
A multifocal IOL may not be suitable for patients treated for Salzmann’s nodular dystrophy because of corneal irregularities that diminish contrast sensitivity; a toric or accommodating IOL may be appropriate for these cases, he said.
- Disclosure: Dr. Basak has no relevant financial disclosures.
Perspective
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David R. Hardten, MD
Dr. Basak’s talk really hits the target for management and identification of irregular astigmatism at the time of cataract surgery. Now with many options for reduction of regular astigmatism at the same time as cataract surgery, such as toric IOLs, femtosecond arcuate incisions, blade arcuate incisions, or a combination of technologies, this is ever increasingly important. Many patients have irregular astigmatism, as he points out in the examples of pterygia, anterior basement membrane dystrophy and Salzmann’s dystrophy. These forms of “irregular” astigmatism are not managed with tools for regular astigmatism, such as toric IOLs or arcuate incisions. They need to be managed with other techniques. If these forms of irregular astigmatism are present, then satisfaction with cataract surgery, especially presbyopic IOLs, will be less.
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