CATARACT WITH SJOGREN 'S SYNDROME : TIPS AND TRICKS

Surface diseases are becoming a more common cause of consultation nowadays. Ageneral prevalence of dry eye disease is around 30%. Within these diseases there are multiples causes, one widely known is Sjogren's syndrome.

Precorneal tear film is the most powerful refracting medium of the ocular surface.

Its integrity is crucial to carry out precision tests such as topography, tonometry and biometric measurements

A 65 year old female with a history of sjogren's syndrome since 10 years ago, with history of multiple treatement. In the moment she started with cataract changes, given the relapse of the ocular involvement with severe filamentous keratitis in both eyes but specially in OS, it was decided to optimize first the ocular surface with treatement. In addition, the patient was referred for evaluation by her rheumatologist who changed her chronic treatement for 30 mg/ day of prednisolone instead of 5 mg/ day. 

At the time of mature cataracts were presented. The biometries performed were unreliable despite taking different images by different methods and biometric calculators, in which none of them managed to have reproducibility of the keratometric measurements and for this reason it was not possible to predict the power of the lens to be implanted because of the severity of ocular surface. The high risk of postoperative refractive surprises was clearly explained. During the surgical procedure , a refraction in aphakia was performed, with a conversion factor multiplied by 2, justified by the scientific literature on the calculation of IOL in patients with previous refractive surgery, which, although it was not the case of our patient, was the closest literature support available for decision-making added to pre-surgical data.

One-month post -op, the patient had a refraction of -1,00 (-1,25 >< 170°) for OS and -0,50 (-0,25><145°). Persisting with mild filamentous keratitis with greater involvement of the OD that achieves symptomatic control with bandage contact lenses, transition aerial lenses to control photophobia and sodium hyaluronate 0,4% eye drops preservative free.

The first fundamental step in this type of patient is to choose the right time to perform any type of intraocular intervention.

This decision must be made once optimal control of the ocular surface is achieved.

Despite the fact that there are indications and algorithms in the literature for those patients with pre-op ocular surface compromise, all of them clearly state stabilizing the compromise before intervening, but none of them give information on what to do in case of not being able to improve the keratopathy due to DED and that is why in our case we were limited to scientific recommendations for IOL calculation.