Photorefractive keratectomy or laser in situ keratomileusis for residual refractive error after phakic intraocular lens implantation

Abstract

Purpose To evaluate the results of combining phakic posterior chamber intraocular lens (IOL) implantation and excimer corneal surgery to treat high myopia or myopia with astigmatism. Setting Service d’Ophtalmologie, Hôpital Purpan, University of Toulouse, Toulouse, France. Methods Thirty-two eyes of 28 patients with extreme myopia or myopia combined with astigmatism were treated by implantation of a phakic posterior chamber IOL. Residual refractive errors were treated no earlier than 6 weeks after IOL implantation by photorefractive keratectomy (PRK) in eyes with low refractive errors or by laser in situ keratomileusis (LASIK) in eyes with higher residual refractive errors. Results The mean preoperative spherical equivalent (SE) refraction was −18.7 diopters (D). The refractive astigmatism ranged from 0 to 3.5 D. After excimer laser treatment, the SE refraction ranged from −0.5 to −2.5 D and the refractive astigmatism, from 0 to 1.5 D in the PRK group. In the LASIK group, spherical ametropia ranged from −1.5 to +1.5 D and astigmatism, from 0 to 1.0 D. After excimer laser treatment, the uncorrected visual acuity improved in all eyes but a loss of 1 line of the corrected vision after IOL implantation occurred in 22.2% of PRK-treated eyes and in 13.6% of LASIK-treated eyes. Conclusion Bioptic treatment of extreme myopia and myopia associated with astigmatism appears to be safer and more predictable than other methods of treatment.