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Residual refractive error requires careful exam for cause
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KOLOA, Hawaii — Surgeons seeking to correct refractive error after toric IOL implantation must carefully seek the cause of the error before choosing the appropriate surgical procedure, according to a speaker here.
“You should have a methodical approach when you are treating residual refractive error,” Elizabeth Yeu, MD, said at Hawaiian Eye 2017. “Find the cause ... and treat that first. Try to take care of [the patients] with spectacles or a soft contact lens in the interim, while they are healing.”
Elizabeth Yeu
The enhancement surgery that follows should be determined by factors ranging from degree and type of astigmatism to tolerance of residual spherical equivalent, Yeu added.
For instance, if the surgeon is treating residual mixed astigmatism of 1.25 D or less, corneal relaxing incisions may be appropriate. If the astigmatism measures more than 1.5 D, the surgeon could choose IOL realignment or exchange or laser vision correction, depending on the circumstances.
A relaxing incision could be appropriate for undercorrected residual mixed astigmatism, Yeu said, adding that, in the same case, the surgeon could lengthen an existing incision or make another one central to it.
Relaxing incisions can likewise be the approach for overcorrected residual mixed astigmatism, as can a flipped axis toric IOL.
Should a surgeon choose laser vision correction in any case, Yeu stressed that “timing is everything.” She urged putting the procedure off for at least 2 to 3 months after cataract surgery and performing posterior capsulotomy before laser treatment. – by Joe Green
Reference:
Yeu E. Post toric intraocular lens surprises: Rotate, relax, zap or exchange it. Presented at: Hawaiian Eye 2017; Jan. 14-20, 2017; Koloa, Hawaii.
Disclosure: Yeu reports she is on the speakers bureaus of Abbott Medical Optics, Alcon, Allergan, Bio-Tissue, Ocular Therapeutix, Omeros, Shire and TearLab; has ownership interest in Modernizing Medicine, RPS and Strathspey Crown; and is on the advisory boards of Abbott Medical Optics, Alcon, Allergan, ArcScan, Bausch + Lomb/Valeant, Bio-Tissue, Eyekon E.R.D., i-Optics, Kala Pharmaceuticals, Ocular Therapeutix, Ocusoft, TearLab and TearScience.