Diagnose, treat corneal irregularities before cataract or refractive surgery
SAN FRANCISCO — Corneal irregularities and opacities should be diagnosed and treated before surgery, according to a speaker here.
“These are conditions that we all see every day or every week in practice, and we’re talking about things that every one of us in the audience can do at any time,” Christopher J. Rapuano, MD, said at Cornea Subspecialty Day at the American Academy of Ophthalmology annual meeting.
Corneal irregularities, including epithelial basement membrane dystrophy, Salzmann’s nodular degeneration and band keratopathy, can all be treated before cataract or refractive surgery to ensure best outcomes, he said.
“When we diagnose these conditions preoperatively, it’s the patient’s problem. When it’s only done postoperatively, it becomes the surgeon’s problem, so you want to keep that in mind,” Rapuano said.
For epithelial basement membrane dystrophy (EBMD), which can cause loose epithelium, leading to recurrent erosion and painful episodes, as well as irregular astigmatism, treatment should be considered if there is negative fluorescein staining centrally or if irregularity is seen on topography.
Treatment includes debridement alone, debridement with diamond burr polishing or debridement with excimer laser PTK, he said.
Treatment for Salzmann’s nodule degeneration should be considered in the presence of irregular astigmatism. Rapuano suggested using lamellar keratectomy with or without a diamond burr polishing.
“Often you can get a nice smooth basement membrane, but sometimes you can’t and that’s when I like to use excimer laser PTK, usually combined with mitomycin,” Rapuano said.
If a patient has band keratopahy, a workup for etiology is required and then treatment is with ethylene diamine tetra-acetic acid (EDTA) chelation.
“[Cornea irregularities and opacities] are especially important to diagnose before cataract or refractive surgery,” according to Rapuano. “There are excellent treatment options you can do right in the office and get super results.” – by Rebecca L. Forand
Reference: Rapuano C. Managing lumps, bumps and dumps on the cornea. Presented at: American Academy of Ophthalmology annual meeting; Oct. 11-15, 2019; San Francisco.
Disclosure: Rapuano reports no relevant financial disclosures.