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Refractive outcome of cataract surgery in a patient with previous photorefractive keratectomy (PRK), sulcus phakic IOL (implantable contact lens, ICL) and astigmatic keratotomy (AK)

Poster Details

First Author: A.Dumitrescu Dragan ROMANIA

Co Author(s):    M. Elgohary   S. Koay                 

Abstract Details

Purpose:

Present the challenging case of a patient who has had 3 refractive procedures in the right eye undergoing cataract surgery

Setting:

Royal Eye Unit, Kingston Hospital, United Kingdom

Methods:

Case report of a 62 year old male, highly myopic (aprox -8 dioptres), who underwent PRK for the right eye as investigational patient 22 years ago. The result of PRK was hypermetropic overcorrection of �.0 which later stabilised at �.50 with severe anisometropia. Seven years later he had bilateral ICL implanted and astigmatic keratotomy with good refractive outcome. However, 15years later he develops visually significant anterior subcapsular opacities in the right eye for which he has cataract surgery in our Eye Department. Financial Disclosure: NONE

Results:

History and old notes were reviewed. Current findings include BCVA of 6/9 (right) and 6/4 (left). Examination shows bilateral prior arcuate corneal incisions, peripheral iridotomy, well-centered ICLs and right eye anterior subcapsular opacity. Biometry was performed on IOLMaster and Haigis-L myopic formula was used. Pre-PRK keratometry and pre-ICL refraction were used on ASCRS IOL calculator. The IOL was chosen to aim for emmetropia. He underwent explantation of the ICL then uneventful cataract surgery. Post-op refraction showed a spherical equivalent of �.50 which offered the patient 6/9 unaided visual acuity which can be corrected to 6/6.

Conclusions:

The most common type of cataract in eyes with ICL is anterior subcapsular opacification caused by insufficient CL vaulting and ICL-lens contact. The possible sources of error in measurement are PRK-induced flattening of the cornea surface and axial lens and anterior chamber depth measurements errors induced by ICL. The previous AK is not considered to influence measurements. Multiple refractive procedures become more popular and consistently accurate IOL calculation remains challenging despite better technology and formulas. It is, therefore, very important to manage patient expectations as they may require spectacles, contact lenses or another procedure to achieve the best visual acuity.

Financial Disclosure:

NONE

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