Eyeworld Daily News

MAY 17, 2020 | EYEWORLD DAILY NEWS | 53 DAILY NEWS ASCRS VIRTUAL ANNUAL MEETING paper on "Trends of Under and Over Correction of Astigmatism with Toric IOLs," which ana- lyzed data from astigmatismfix. com. The purpose of the study was to analyze trends from astigmatismfix.com entries to better assess under and over correction of astigmatism with toric IOLs and to evaluate the effect of intraoperative aber- rometry on astigmatism under/ over correction. Dr. Kramer first offered a bit of background on corneal astigmatism. In 2012, Doug Koch, MD, and Li Wang, MD, PhD, published a landmark study that shined a light on posterior corneal astigmatism, and the following year, they published the Baylor toric nomogram. He noted that posterior corneal astigmatism contributes against-the-rule astigmatism from an overall refractive standpoint. If the posterior corneal astigmatism goes unaccounted for in toric IOL calculations, there will be an under correction of against- the-rule astigmatism and an were within ±0.75 D of MRSE. In terms of visual outcomes, 75% of eyes had postop UDVA 20/32 or better, and all eyes had postop CDVA of 20/32 or better. In conclusion, Dr. McKee said that this small pilot series suggests that femtosecond laser-assisted cataract sur- gery can be performed safely in cataractous eyes through coexisting corneal endotheli- al dystrophies. Femtosecond laser-assisted arcuate keratot- omy combined with FLACS and DMEK was effective in improving visual and refrac- tive outcomes in patients with coexisting cataract and endothelium dysfunction. All eyes had postoperative residual refractive astigma- tism within ±1.0 D and 75% eyes were within ±0.5 D. Iris registration-guided automatic cyclotorsion compensation and improved nomogram for arcu- ate keratotomy help achieve excellent astigmatic outcomes, he said, adding that no in- traoperative or postoperative complications were observed. Brent Kramer, MD, Chapel Hill, North Carolina, shared a cataract surgery with DMEK yields more predictable refrac- tive outcomes than DSAEK or PK. But can outcomes of the DMEK triple procedure be further improved by addressing preexisting corneal astigma- tism at the time of cataract surgery? Dr. McKee said that femtosecond laser-assisted arcuate keratotomy combined with the DMEK triple proce- dure may further improve the visual and refractive outcomes in astigmatic eyes of patients with cataract and endothelium dysfunction. The purpose of his study was to evaluate the safety and efficacy of a combined procedure of femtosecond laser-assisted arcuate kera- totomy, cataract surgery, and DMEK in patients suffering from endothelial dysfunction, age-related cataract, and corneal astigmatism (0.45 D–1.95 D). The study was a retrospective chart review of eight eyes of eight patients that underwent femtosecond laser-assisted AK, FLACS, and DMEK. The LENSAR laser with iris registration for cyclotor- sion compensation was used. Refractive stability and out- comes were evaluated through 3 months postop. Outcome measures were UDVA, CDVA, manifest refraction spherical equivalent, and residual refrac- tive astigmatism. There was significant reduction in astigmatism from 0.9 D preop to 0.34 D postop, Dr. McKee said. Additionally, postop residual refractive astig- matism was less than or equal to 0.5 D in 75% of eyes. He added that 100% of patients were less than 1 D postoper- atively for residual refractive astigmatism. In terms of manifest re- fraction, nearly 75% of eyes by Ellen Stodola Editorial Co-Director D uring a paper session on astigmatism man- agement and toric IOL alignment, Yuri McKee, MD, Mesa, Arizona, presented "Efficacy of Combined Fem- tosecond Laser Assisted Cat- aract Extraction with Arcuate Keratotomy and Descemet's Membrane Endothelial Kerato- plasty." Management of endothelial dysfunction with coexisting cataract often benefits from a concurrent (triple procedure) approach to address both of the conditions, Dr. McKee said. Advantages of the triple proce- dure (cataract extraction, IOL implantation, and DMEK) are smaller incisions, faster visual rehabilitation, and no further endothelial damage induced by sequential cataract surgery. Researchers have shown that graft rejection rates are un- equivocally lowest after DMEK, as compared to other corneal transplant modalities, he said. Although PK has previously been combined with cataract surgery in patients with corneal diseases, significant alteration of the anterior and posterior curvature during PK reduc- es the predictability of the postoperative refraction and often induces higher spherical and cylindrical alterations, Dr. McKee said, adding that rejection rates are also higher with PK. Without disruption of the anterior corneal lamella refractive considerations can be incorporated into preoperative planning. DSAEK is associated with at least some thickness of the stromal lamella, which may influence the final refractive outcomes, Dr. McKee said. DMEK has less effect on refrac- tive shifts. Thus, combining Paper session highlights astigmatism and toric alignment Femtosecond laser-assisted arcuate keratotomy combined with FLACS and DMEK was effective in improving visual and refractive outcomes in patients with coexisting cataract and endothelium dysfunction. continued on page 54

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