Clear lens extraction with intraocular lens followed by photorefractive keratectomy or laser in situ keratomileusis

Abstract

Objective To study photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK) after clear lens extraction (CLE) with intraocular lens (IOL) implantation for hyperopia or astigmatism. Design Retrospective, noncomparative interventional case series. Participants Sixty-five eyes (55 subjects) had CLE with posterior chamber IOL implants for hyperopia up to 12.25 diopters (D); 31 eyes were retreated with PRK, and 34 eyes were retreated with LASIK for residual ametropias. Intervention For PRK and LASIK, the refractive surgery was performed with the slit-scanning excimer laser Nidek EC-5000, Nidek Co., Tokyo, Japan. Main outcome measures Manifest refraction, best-spectacle and uncorrected Snellen visual acuity, haze, and halos were evaluated before surgery and at 1, 3, 6, and 12 months postoperative. Results Forty-seven eyes were evaluated at the 12-month postoperative examination: 96% of these eyes had spherical equivalents (SE) within ±2 D of emmetropia, 79% of eyes had SE within ±1 D of emmetropia and 51% of eyes had SE within ±0.50 D of emmetropia. Eighty-five percent of the eyes at 12 months postoperative had uncorrected visual acuity of 20/40 or better, and 46% of eyes had uncorrected visual acuity of 20/20 or better. Eighty-seven percent of the eyes at 12 months postoperative had uncorrected visual acuity within 1 Snellen line of their initial best spectacle-corrected visual acuity (BSCVA) before all treatment. No eye lost 2 Snellen lines of BSCVA at 3, 6, or 12 months after PRK or after LASIK. Conclusions IOL implantation for CLE, although an invasive technique, resulted in better refractive outcomes without laser-related clinical complications after PRK or LASIK adjustment.