Refractive Management Of Surgical Induced Presbyopia In A Young Patient With Vision-Related Quality Of Life Complaints.

Visual difficulties can negatively impact life quality, particularly in the case of near vision loss in young patients. Our purpose is to report the refractive management of a young patient previously submitted to bilateral phacoemulsification with monofocal intraocular lens (IOL) implantation, who was unsatisfied with her vision-related life quality

Refractive Surgery Unit, Ophthalmology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal

A 32 years-old woman was referred to the Refractive Surgery Unit of Centro Hospitalar Universitário de Santo António. She had been submitted to bilateral phacoemulsification with monofocal intraocular lens (IOL) implantation and Nd:YAG LASER posterior capsulotomy three years before, in another institution, due to congenital cataracts. In addition to presbyopia, the patient had mixed astigmatism (+1.00-4.00x10º in the right eye and +0.50-1.75x180º in the left eye). She did not tolerate contact lenses and felt that her vision significantly impaired her life quality. Due to the presence of a posterior capsulotomy, lens explantation could be technically difficult, hence, the surgeon decided to implant a Sulcoflex IOL. As multifocal toric Sulcoflex IOLs are not available, two refractive procedures were necessary. Firstly, a spherical trifocal Sulcoflex IOL was implanted to correct the spherical refractive error and the presbyopia. After surgery, visual acuity was 20/20 (Snellen Scale) in both eyes, with a residual astigmatism of -3.50x10º in the right eye and -1.50x170º in the left eye, without significant complaints of halos or glare. In a second time, a photorefractive keratectomy was performed to correct the residual astigmatism. In the last visit, distance and near uncorrected visual acuity were 20/20 (Snellen) and Jaeger 1, respectively, in both eyes. The patient was very happy with the surgical outcome and felt that it significantly improved her life quality.

When assessing the surgical options of young, working-age patients, clinicians should bear in mind alternative solutions to monofocal IOLs. The Trifocal Sulcoflex IOL can be a good option as it allows correction of both the distance and near refractive error, while being a reversible procedure, if the patient cannot tolerate a multifocal IOL. In this case, the combination of both corneal and intraocular procedures allowed our patient to obtain full eyeglass independency and significantly improved the patient’s life quality.