the implants tend to cost more. Nevertheless, inserting corrective
lenses during cataract surgery is becoming a wonderful option for
eliminating astigmatism.
4
Address it
Once the plan is in place, it's our job as a surgical team to ensure
it is properly executed. Every step, from the initial, in-office eval-
uation to patching the corrected eye at the end of the procedure, is a
potential error source. That's why it's essential for the surgical staff to
be on the same page as the surgeon. We mark the eye to create a refer-
ence point for surgery. We either use surgical cameras to intraopera-
tively confirm the IOL is where it's supposed to be aligned or make
alignment marks at 6 o'clock and 12 o'clock on the patient's numbed
eye. When I'm performing surgery, I put a simple sticky note on the
operating machine that tells me the lens power and rotation where it
should end up. The scrub nurse uses a sterile marker to write the same
numbers down elsewhere — with the promise not to let me out of the
surgical suite until we confirm the lens is where it should be.
5
Tweak it
As with all surgeries, astigmatism correction requires some
post-operative management. Often patients need a minor touch-
up procedure, which is often part of the package for premium
patients. While most implantable lenses are quite stable, they do
sometimes rotate away from their intended location post-surgery. To
correct this, the surgeon can do a minor procedure to make a small
adjustment of the tilt in the eye.
OSM
8 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 7
Dr. Kelley (kelley5@columbus.rr.com) is a founding member and
physician-owner at the Eye Center of Columbus (Ohio) and the director
of refractive surgery of Arena Eye Surgeons.