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Experts weigh whether corneal lesions should be removed before or during cataract surgery
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SAN FRANCISCO — Corneal lesions should be removed before cataract surgery, one speaker said, while another advocated simultaneous corneal management and cataract surgery.
During Cornea Day preceding the American Society of Cataract and Refractive Surgery meeting, Richard S. Davidson, MD, and Maria A. Woodward, MD, debated the merits of successive vs. simultaneous corneal management and cataract surgery.
Richard S. Davidson
"Performing IOL calculations before cataract surgery requires precise measurements of the shape of the cornea," Davidson said. "Lesions such as pterygia and Salzmann’s nodules can induce regular and irregular astigmatism. Irregular astigmatism can really result in a suboptimal visual outcome."
Davidson recommended removing lesions at least 3 months before cataract surgery to let the cornea heal and stabilize. In addition, the cornea should be examined thoroughly before cataract surgery, he said.
Maria A. Woodward
Small lesions may be left alone provided they are not expected to change or worsen after cataract surgery, Davidson said.
Woodward said simultaneous corneal and cataract surgery best meets patient expectations. In addition, simultaneous surgery involves shorter recovery time, lower costs, fewer office visits, and fewer financial and logistical burdens on patients and their families than sequential surgery, she said.
"I believe this approach can be feasible with current technology," Woodward said. For example, intraoperative wavefront aberrometry can be used to assess aphakic refraction and choose an appropriate IOL, she said.
Further study is needed to gauge the efficacy of simultaneous corneal and cataract surgery, Woodward said.
Disclosures: Davidson and Woodward have no relevant financial disclosures.