SAN FRANCISCO — Use of PRK to manage refractive errors after cataract surgery poses various challenges, a speaker said here.
When encountering post-cataract refractive errors, the surgeon must know what he or she faces and be prepared to take action, Karl G. Stonecipher, MD, said during Cornea Day preceding the American Society of Cataract and Refractive Surgery meeting.
"We’ve got to know when to bail, and we’ve got to know when to stay in there and fight the good fight," Stonecipher said.
Stonecipher emhasized the need to use a nomogram before performing a post-cataract enhancement.
"Just because it’s an enhancement, a lot of people don’t do an enhancement nomogram," he said. "To do an enhancement with a laser is the same thing as doing a virgin eye. Even harder, probably, because there’s a lot more involved, and patient healing factors are a lot more involved."
Stonecipher said he prefers transepithelial PRK for cases of myopia and myopic astigmatism. Removing the epithelium with alcohol is preferred in cases of hyperopia and hyperopic astigmatism, he said.
Application of mitomycin C should be a standard protocol, Stonecipher said. Mitomycin C will likely be dispensed differently because of compounding pharmacy concerns, he said.
"We’re probably going to have to write the patients’ prescriptions, and we’re probably going to have to control a little bit more," Stonecipher said. Regulations will vary state to state, he said.
Disclosure: Stonecipher has no relevant financial disclosures.