Careful biometry and corneal health are as important as choice of formula.
Review of Ophthalmology | January 2017 | Kristine Brennan, Senior Associate Editor
Dr. Harold Ridley (1906-2001), who implanted the first intraocular lens in 1949, lived to see cataract surgery evolve into a true refractive procedure, undergoing IOL implantations himself in 1989 and 1990. Today, outcomes within half a diopter or less of target are attainable in most normal eyes, but some cases continue to present challenges. This article provides insights from seasoned cataract surgeons about how to maximize your outcomes and includes brief discussions of specific types of challenging eyes.
Preop Workup is Critical
“I can have a long eye, a short eye or a post-LASIK eye, but the most im- portant thing I do is give them all the same thorough preoperative workup,” emphasizes P. Dee Stephenson, MD, FACS, president of the American College of Eye Surgeons, associate professor at University of South Florida College of Medicine in Tampa and CEO/CFO of Stephenson Eye Associates. “I use the IOLMaster 700, the Cassini and the iTrace on every patient. I also do an OCT of the macula to make sure there is no pathology.”
Samir Sayegh, MD, PhD, FACS, of the Eye Center in Champaign, Illinois, also considers a meticulous workup fundamental to a good refractive outcome. “We have a routine that applies to all eyes identified as being particularly exceptional,” he says. “We do a lot of repeat testing. We do partial coherence interferometry using the IOLMaster for axial length, and we do ultrasound. We do both every time, for every patient. For the measurement of the K value, we use at least three methods. Another thing we do is OCT of the retina for all patients. We also do pachymetry on all patients.”
Dr. Sayegh says these measures help to reveal any pathology ahead of time. “Everybody having cataract surgery will get OCT, and they will get evaluation of the thickness of the cornea, so that if there is underlying Fuchs’ or anything that would be an issue at the time of surgery, we can take extra care with the eye. If there’s anything that would show up later, in the postop results, we also want to know ahead of time.”
As IOL implantation inches closer to the long-term goal of emmetropia, surgeons implant challenging eyes with a more immediate goal: patient satisfaction and well-being. “You can plan all you want,” says Dr. Stephenson, “but sometimes there are surprises, and you have to look at the gestalt of the situation and make a decision that you think will be best for the patient.”
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