An afternoon session on Sunday, April 27, featured case-based discussion on the management and treatment of various corneal diseases in the preoperative cataract patient. The session was moderated by Brandon Ayres, MD, and Sumitra Khandelwal, MD, and was sponsored by the ASCRS Cornea Clinical Committee.
Amy Lin, MD, shared a case of a preoperative cataract patient with pterygium. She first questioned if you should do a combination case or sequential for these patients but said that she doesn’t do cataract surgery at the same time as pterygium because there are changes with topography and Ks that will happen for several weeks after.
Dr. Lin’s case was a 79-year-old man in whom she had done the pterygium surgery in his right eye several years prior. He had some residual nasal scarring in that eye. Now he had a nasal pterygium in his left eye.
The right eye had flattening in the periphery, and the left eye had irregular flattening and a current pterygium.
Dr. Lin said she had several approaches to choose from and ultimately chose to do phaco in the right eye, pterygium excision in the left eye, and phaco at a later time in the left eye.
The patient was happy after the cataract surgery in his right eye. Two weeks later, Dr. Lin did pterygium surgery in the left eye. Shortly after the procedure, the patient’s vision in the left eye was better than the right eye that had cataract surgery. She decided to forego phaco in the left eye and give the patient a glasses prescription. Two years later, the left eye still refracts to 20/25+2. This is an example of when pterygium surgery alone achieved the visual refractive outcome that we wanted, Dr. Lin said.
In summary, she said that if topography shows a significant astigmatism due to pterygium, perform pterygium excision first, then wait at least a month to biometry/phaco. Sometimes pterygium surgery alone can significantly improve the vision.
Panelists at the session also discussed timing for cataract surgery when a pterygium is present. Elmer Tu, MD, said when you have a pterygium in one eye, he might suggest pterygium then doing the cataract later; he has also seen cases where the vision improved after pterygium surgery without cataract surgery. He added that it may be hard to put these patients off when you tell them they need to wait for 2 or 3 months. “I’ll try to wait as long as possible after the pterygium is taken out,” he said. “The soonest I would do it is a month.”
Dr. Khandelwal said that sometimes showing the patient their topography is powerful. “I like to show the mires because it shows how irregular the cornea is,” she said.
Relevant disclosures
Lin: None
