Abstract
Three cases of patients who developed a similar hyperopic defect in refraction following laser in situ keratomileusis (LASIK) after multifocal intraocular lens (IOL) implantation are described. Ophthalmologic evaluation including refractive status, corrected and uncorrected visual acuity (both at far and near), and corneal topography in patients presenting similar hyperopic refractive surprise in one eye as a result of LASIK refinement of residual ametropia after refractive multifocal IOL implantation. Laser in situ keratomileusis enhancement for residual ametropia of -1.00 to -1.50 D in patients with a prior implantation of refractive multifocal IOL resulted in a refractive surprise of +2.25 to +2.50 D. After excluding other possible sources of error, an explanation for such a refractive surprise is suggested, and a simple method for avoiding this error is presented. Proper knowledge of the defocus curve and the use of a systematic method for determining subjective refraction in patients implanted with refractive multifocal IOLs will reduce the possibility of refractive surprise after LASIK enhancement in a bioptics procedure.
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