Extra care essential for cataract with ocular surface disease

Great care and detailed assessment are essential for cataract extractions where another ocular surface disease (OSD) is present, Thomas Neuhann said. Diseases range from dry eye, conjuntivalisation, irregular surfaces and corneal scars.

He said such combined presentations were rare, but they posed specific problems in the pre-, intra- and postoperative stages. In preoperative keratometry, IOL calculation is difficult and expected outcome hard to assess, while during the procedure visualisation of the capsule is problematic with an obscured cornea.

Finally, postoperative conflicts often arise between treatment of the cataract and treatment of the OSD.

During the procedure it is particularly important to take care with the capsulorhexis. "It is better to take a minute or two extra during the procedure to get it right. It's important to go very carefully," he emphasised. He added that dyes can be very useful and they are an underused resource. "If you use trypan blue it can help a lot once you've lifted the capsule," he noted.

For phaco he said it was important to ". . . err on the corneal side, if I can use that expression. You should also lift out the nucleus more than you usually do, but protect the eye with generous use of dispersing viscoelastic." Postoperatively preservative-free eye drops must also be used.

But the most important issue is to assess whether there will be any benefit for the patient. "There's no point in doing the procedure if there's little chance of improved vision for the patient," he said.

Assessing expected outcome is hard, but he recommended that surgeons try lubricating during keratometry. If it still proves impossible, surgeons should try assessment on the other eye. "Finally, if that doesn't work, try a best guess."

Ophthalmology Times Europe reporting from the XXIV Congress of the ESCRS, London, 9-13 September, 2006.