Excimer Laser Phototherapeutic Keratectomy Before Cataract Extraction and Intraocular Lens Implantation

Abstract

To determine whether sequential excimer laser phototherapeutic keratectomy (PTK) followed by cataract extraction and intraocular lens (IOL) implantation with power calculation based on the new corneal curvature is effective in managing superficial corneal disease. Of a consecutive series of 18 eyes of 16 patients who received PTK, extracapsular cataract extraction, and posterior chamber IOL insertion, twelve eyes had spheroidal degeneration and six eyes, calcific band keratopathy. The PTK was done with either a Summit ExciMed laser or a Visx 20/20 laser using a 5.0 to 6.0 mm diameter ablation zone. Intraocular lens calculations were done a mean of 3.3 months after PTK. Cataract surgery was by extracapsular cataract extraction with posterior chamber IOL implantation. Patients were followed up for a mean of 14 months. Eighteen eyes completed follow-up examinations. Mean time between PTK and cataract surgery was 3.3 months. Phototherapeutic keratectomy was completed in one surgery session using one ablation treatment (ablation and slitlamp microscopy) in five eyes, two treatments in seven eyes, and three to seven treatments in six eyes. Eleven (61%) of 18 eyes had a final spherical equivalent refraction within +/- 1.00 diopter. Two eyes developed moderate to marked subepithelial reticular corneal haze from PTK. No vision-threatening complications occurred. Excimer laser PTK followed by cataract extraction and posterior chamber IOL implantation can safely and effectively treat eyes with superficial corneal disease and age-related cataract. Calculation of the IOL power after the cornea has healed from the PTK compensates for changes in corneal curvature.