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First Author: J.Huxtable UK
Co Author(s): H. Usmani I. Rahman
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To evaluate the effectiveness of the light-adjustable intraocular lens (LAL; Calhoun Vision Inc, Pasadena, USA) implanted during routine phacoemulsification in eyes previously treated with LASIK.
Spire Fylde Coast Hospital, Blackpool, United Kingdom.
In this retrospective case series, 12 eyes of 7 patients were identified as having undergone routine phacoemulsification with insertion of a LAL between July 2010 and July 2011. All eyes had previously undergone LASIK refractive surgery in the past. Preoperative data for refractive error, BCVA and target refraction were recorded. Biometry was calculated using Haigis-L. Following the procedure, all patients were given UV protection until their adjustment visit. At each adjustment visit, refraction was recorded with adjustments made as necessary until the desired refractive outcome had been achieved at which point lock-in was performed. Following this, visual acuity and refraction were recorded. The main outcome measure in this series was the final post-adjustment mean spherical equivalent (SE) compared with the targeted refraction. As all patients had opted for monovision as a means of presbyopic correction the secondary outcome measure in the series were the binocular visual acuities for near and distance.
Twelve eyes of 7 patients (4 male, 3 female; mean age 49 years [range 39 - 68]) were implanted. Five had both eyes treated. Mean preoperative spherical equivalent (SE) was -0.01D (range -3.50 to +2.75). In the 7 dominant eyes targeted for emmetropia, the post-operative, pre-adjustment SE was +1.11D (range:-0.63 to +2.75) with +0.33D (range:-0.68 to +2.75, p=0.46) mean SE at 8 months follow up. Mean best corrected visual acuity was 6/7.5 (range 6/5 - 6/9). For 5 non-dominant eyes, targeted for near, mean target SE was -1.35D (range:-1.25 to -1.50). Mean pre-operative SE was +0.60D (range:-0.50 to 2.75). The post-operative, pre-adjustment SE was -1.33D (range -2 to -1) with mean SE at 6 months follow up of -1.15D (range:-0.5 to -1.15). Mean near acuity was N7 (range: N6-N10). Of the 12 eyes, 9 (75.0%) were within +/-0.25D of the desired target refraction. The target SE differed from post-operative, pre-adjustment SE by a mean 0.85D and from post-adjustment SE by 0.39D (p=0.045). One eye underwent repeat procedure for an unexpected hyperopic shift. Six of seven (85.7%) patients had binocular near vision of N6 or better. Six (85.7%) achieved both a binocular vision of 6/9 and N6 or better.
Appropriate intraocular lens selection in eyes previously treated with LASIK refractive surgery represent a significant challenge which carries a considerable risk of refractive surprise. The advent of light-adjustable lens (LAL) technology offers the unique option to customise and adjust postoperative refractions non-invasively which can be of considerable benefit in these patients. Despite the increasing popularity of LAL there are no reports in the published literature which assess their use in post-LASIK eyes. Our results demonstrate that in post-LASIK eyes, the LAL can be used to achieve predictable refractive outcomes in the majority of cases with 75.0% of patients within +/-0.25D of their refractive target. There was a statistically significant difference (p=0.045) in the difference in mean SE from the target compared to the pre- and post-adjustment SE demonstrating the benefit of non-invasive adjustments. In addition, our results show that in post-LASIK eyes, the LAL can be used to achieve customised, predictable and effective spectacle independence through monovision with a success rate of 85.7% in this series.