Beckman shares pearls for cataract surgery in cases of herpetic disease
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WAIKOLOA, Hawaii — A presenter at Hawaiian Eye 2022 offered his list of considerations for performing cataract surgery in patients with herpetic disease.
First, Kenneth Beckman, MD, FACS, treats active disease preoperatively.
Among preoperative treatments to be considered are use of oral antivirals, continuation of topical steroids, punctal plug placement, use of frequent lubricants and amniotic membrane graft placement. Beckman manages the ocular surface to allow for accurate measurements and allows the disease to remain quiet for an extended period.
“It’s not uncommon for patients to be constantly flaring back up, and you may only have a short window of time to get this done, so sometimes you have to do it a little quicker than you may want to, but ideally I love to get them quiet for 6 months before I jump into surgery,” he said.
Beckman also assesses corneal scarring using multiple keratometric readings, checking old records and comparing one eye against the other. This will help inform the decision whether to perform penetrating keratoplasty, he said.
The operative view is the primary concern when performing surgery, Beckman said. If the view is clear enough, cataract surgery alone may be performed and vision potential assessed postoperatively. If the view is not clear enough, then Beckman considers PK alone vs. open sky cataract surgery. If the view is clear enough but scarring is significant, then Beckman considers standard phacoemulsification with IOL implantation and subsequent PK at the same time.
Other intraoperative considerations are protection of the epithelium, use of trypan blue, use of coaxial or oblique illumination, and awareness of intraoperative floppy iris syndrome.
After surgery, Beckman said he would slow taper prednisolone acetate, or if the patient is already using steroids, then they could continue their treatment at preoperative levels. Beckman also considers use of antivirals for 2 to 3 weeks until the steroid course is completed. If the patient is already using antivirals, those are continued at the preoperative level, he said.
“You want to continue to monitor them closely during the postop period and use caution with premium lenses,” Beckman said.
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Beckman K. Cataract surgery in the presence of herpetic disease. Presented at: Hawaiian Eye; Jan. 15-21, 2022; Waikoloa, Hawaii.
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