June-July 2020

ASCRS NEWS

Ocular surface considerations prior to different surgeries


by Clara Chan, MD Cornea Editor


Clara Chan, MD Cornea Editor

In this month’s issue of EyeWorld, the featured In Focus articles explore the importance of the ocular surface in the context of corneal transplantation, cataract surgery, and glaucoma surgery. Pterygium surgery pearls are also reviewed. 
Corneal surgery of any form can lead to an iatrogenic epithelial defect, and should underlying neurotrophic keratopathy be missed, the patient will have significant challenges with healing postoperatively.  
A pterygium can cause abnormal MMP-9 testing and irregular corneal astigmatism. Use of a conjunctival autograft is the gold standard after pterygium excision, but amniotic membrane may be utilized to enhance the procedure, and these techniques and other pearls are discussed in further detail.
A paper published by the ASCRS Cornea Clinical Committee in 2019 presented an algorithm for the preoperative diagnosis and treatment of ocular surface disorders.1 The take-home message is for physicians to address dry eye signs and symptoms in patients prior to cataract or refractive surgery. Patients must be aware that eye surgery can worsen dry eye symptoms. The tenet of “do no harm” rings true such that if a patient has visually significant ocular surface disease, they should be treated first, or the reasons why they are not a candidate for a multifocal IOL should be clearly explained.  
The glaucoma patient is exposed to chronic eye drops, preservative toxicity, and chronic ocular surface inflammation. Bleb formation after trabeculectomy surgery changes the ocular surface contour, and glaucoma drainage devices require healthy conjunctiva for good function. While frequently overlooked, managing the ocular surface is a crucial component of managing the glaucoma patient, and one of the feature articles includes some great discussion on this topic.  
I hope you enjoy the articles in this issue of EyeWorld, and remember to assess the ocular surface of every patient.

Reference

1. Starr CE, et al. An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. J Cataract Refract Surg. 2019;45:669–684.

Ocular surface considerations prior to different surgeries Ocular surface considerations prior to different surgeries
Ophthalmology News - EyeWorld Magazine
283 110
283 110
,
2020-06-22T11:21:30Z
True, 6