In-office procedures can regularize corneas before cataract surgery
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WAILEA, Hawaii — Corneal irregularities should not be missed and must be treated before patients are scheduled for cataract surgery to avoid disappointing refractive outcomes.
At Hawaiian Eye 2024, Marjan Farid, MD, gave advice on how to deal with irregular corneas of various etiologies using in-office procedures that optimize the surface and improve candidacy for advanced-technology IOLs.
The characteristic whitish bumps of Salzmann’s nodular degeneration may be subtle and hidden, as shown by Farid in one of her cases.
“Lift the eyelids to look at the superior cornea,” she said.
Corneal topography may reveal a significant amount of irregular astigmatism that needs to be treated before planning for an IOL. After peeling the epithelium off, the nodules can be removed at the slit lamp, and a bandage contact lens is then placed on the surface.
“Give them a month to heal and recheck tomography for regularity,” Farid said.
She then showed a case of epithelial ingrowth under a previous LASIK flap, seen on topography as an area of corneal irregularity extending into the central vision. After removing the epithelium, to avoid reintroducing the ingrowth in another area, the flap was relifted and the epithelial ingrowth was scraped off from both the stromal and the flap interfaces. The flap must be held gently, washed on both sides, put back down and covered with a bandage contact lens, Farid said.
In a case of anterior basement membrane dystrophy, gentle superficial keratectomy, with or without diamond burr polishing, can be performed. Amniotic membrane patching can be used to encourage re-epithelialization and decrease scarring, but a bandage contact lens may work just as well, Farid said.
Recurrent corneal erosion, if the area of irregularity and erosion is distinct, can be treated with stromal micropuncture.
“Those little punctures have to be close enough together because if there are big spaces, you can still get an erosion in between those areas,” Farid said.
Larger areas of erosion can be treated using superficial keratectomy with diamond burr or laser phototherapeutic keratectomy. The key to success, Farid said, is to make these treatments uniform.
“Many procedures can be done in the office to treat these ocular surfaces and corneas in preparation for cataract surgery. Regularize the irregular astigmatism, optimize and recheck these patients after 4 to 6 weeks to make sure you have regularized the cornea, and then do your IOL planning at that time,” Farid said.
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Farid M. In office corneal procedures to prep for cataract surgery. Presented at: Hawaiian Eye 2024; Jan. 13-19, 2024; Wailea, Hawaii.
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