Complicated cases in cataract surgery

Should every toric patient be treated for dry eye even if it is not visible? Should NSAIDs be avoided after surgery in cases with dry eye? What is the best IOL power calculation formula is such situations? These were among the many questions addressed at the 25th ESCRS Winter Meeting Virtual 2021 ‘Meet The Experts’ discussions, where key ESCRS opinion leaders tackled the latest issues in anterior segment surgery while audience members asked questions during 30-minute Zoom sessions. During one of these very useful and practical sessions, on complicated cataract cases, Professor Ewa Mrukwa-Kominek MD​, Poland, outlined a number of complex cataract with glaucoma cases and discussed the best approaches while taking questions. During the same session Guy Sallet MD, Belgium, went through a case where there was refractive surprise, which had been caused by dry eye disease in the patient. It prompted some interesting questions and discussion, including whether a patient with mild dry eye disease should be given lubricants before implanting a toric IOL. Both Dr Sallet and Prof Mrukwa-Kominek agreed the dry eye should be treated before surgery. For moderate or severe dry eye, Prof Mrukwa-Kominek also uses cyclosporin and keeps the patient on it through the surgery period, which also addresses acute inflammation. However, cyclosporin is not commercially available in all countries, including Belgium noted Dr Sallet, who said he uses a low-dose steroid in these cases. In relation to the use of NSAIDs in these patients post-surgery, Dr Sallet said he prescribes NSAIDs in every case, even dry eyes.

Tags: ESCRS Winter Virtual 2021