Even the use of intraoperative aberrometry did not prevent a miscalculation here. First, as encountered in this case, it can be difficult to calculate IOL power accurately, and an error may necessitate additional surgery. I generally avoid multifocal IOLs for post-LASIK patients for several reasons. Obviously, the surgeon will want to minimize the chance that multiple surgeries on the second eye are required. This patient underwent multiple refractive surgeries to attain satisfactory results, and two IOL exchanges in the right eye were required to reach his refractive goal. IOL selection for patients who have a history of corneal refractive surgery is always a challenge. How would you calculate the IOL power, and what type of IOL would you use? He is ready for surgery on the left eye but wants to undergo only a single procedure. UDVA and uncorrected near visual acuity (UNVA) were 20/20 on postoperative day 1, and the patient was happy. The surgery was uncomplicated, and an AcrySof PanOptix IOL (model TNFT00, Alcon) was implanted. I calculated the IOL power (20.00 D) using the Barrett Rx formula. Two months after the initial IOL exchange, the patient returned to the OR for a second IOL exchange. During this time, a trifocal IOL was approved for use in the United States. Although the patient was quite frustrated with the outcome, we agreed to wait several weeks for the refraction to stabilize before deciding what action to take. Best corrected distance visual acuity was 20/20 with a manifest refraction of -1.00 D. Initially UDVA was 20/25, but it was 20/40 at 1 month. The IOL power was calculated using the Barrett Rx formula, and a 20.50 D AcrySof IQ Restor +2.5 D IOL (model SV25T0) was placed. Two weeks later, the refraction was stable at -1.50 D, and an IOL exchange was performed without difficulty. Best corrected distance visual acuity was 20/20 with a manifest refraction of -1.50 D, and near visual acuity was J3. UDVA was 20/30 on postoperative day 1 and 20/50 at 1 week. I used the ASCRS IOL power calculator for prior myopic LASIK/PRK to determine the IOL power (22.00 D) and confirmed the power with intraoperative aberrometry. Macular OCT scans of both eyes.Īfter a discussion with the patient about the risks and benefits of cataract surgery and taking into consideration his desire for good vision at both distance and near, we decided to proceed with cataract surgery on the right eye and the implantation of a low-add multifocal IOL (AcrySof IQ Restor +2.5 D IOL, model SV25T0, Alcon). The posterior examination was normal (Figures 1–3).įigure 3. ![]() A slit-lamp examination of each eye showed a normal anterior segment, a well-centered LASIK flap, and moderate nuclear sclerotic and cortical changes. On examination, uncorrected distance visual acuity (UDVA) was 20/30 OU, which decreased to 20/80 OU with glare testing. He said that he was not sure why multiple procedures were required for the right eye, and he had no record of the procedures or his previous refractions. During the current visit, he stated that it had taken three tries to “get it right” on the right side and only one try on the left. Several years earlier, the patient had undergone LASIK to correct myopia. He said that excellent distance vision was extremely important to him and that he did not want to wear reading glasses. The patient stated that he had enjoyed a visual acuity of 20/15 for most of his life and expressed frustration with the decline he had experienced during the past few years. He reported a reduction in overall quality of vision and glare at night. The patient is an engineer by trade whose hobbies include race car driving and piloting a private aircraft. A 63-year-old man was referred for cataract surgery on both eyes.
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