"Rk: A Rose-Cut Diamond Cornea, The Wonder Of Light Adjustable Lens, And Ic-8 After Radial Keratotomy - A Case Report"
Published 2024 - 42nd Congress of the ESCRS
Reference: PO060 | Type: Case Report | DOI: 10.82333/y1hm-4t95
Authors: Nousal Wergenthaler* 1 , Mitchell Shultz 2 , Tim Schultz 1 , H Burkhard Dick 1
1University Eye Hospital,Bochum,Germany, 2Shultz Chang Vision,Los Angeles,United States
Purpose
A retrospective analysis of a case of femtosecond laser-assisted cataract surgery (FLACS) after previous radial
keratotomy (RK), with implantation of a light adjustable intraocular lens (LAL, Rx Sight) with activShield™ in one eye and
IC-8 (B&L) in the other eye.
Setting
The surgery was performed at the University Eye Clinic Bochum in Germany, and the following examinations and
light treatments were performed at Schultz Chang Vision Center in the USA.
Report of case
A 61-year-old woman with a history of RK and prior laser in-situ keratomileusis (LASIK) underwent bilateral
simultaneous FLACS with implantation of IC-8 in the right eye and LAL in the left eye. Multiple measurements were
performed preoperatively and postoperatively for both eyes. A comparison of both eyes has been performed. The right
eye had 12 RK cuts, and the left eye had 16 RK cuts. The FLACS was performed by a single operator using the ASCRS
IOL Calculator for post-RK, aiming for emmetropia. Preoperatively, the mean subjective refraction (MSR) and best
corrected visual acuity (CDVA) in OD were +3.0 -3.75x65°, (20/80) 0.6021 LogMAR, and in OS +7.75 -5.75x97°, (20/80)
0.6021 LogMAR.
Three months postoperatively, the MSR and CDVA in the right eye (OD) were +0.5 -0.5x92° (20/50), 0.398 LogMAR, and
in the left eye (OS) were 0 -2.0x105° (20/70), 0.544 LogMAR. The keratometric astigmatism in the left eye, at (-9.0 D),
was higher than in the right eye, and showed postoperatively marked fluctuation (-9.0 and -7.0 D). Even after two light
treatments, the keratometric astigmatism remained unstable. Postoperatively, a fluctuation of subjective manifest
refraction in both eyes has been noted, especially in the LAL-treated eye. The light adjustable lens was adjusted two
times. Finally, the patient chose not to have any more light adjustments and decided to wear contact lenses.
Conclusion/Take home message
The combination of IC8 and LAL showed good refractive outcomes in eyes with prior RK.
The challenge still lies in the refraction fluctuation, especially the astigmatic keratometry after RK, and also the limitation
of LAL in high astigmatic correction. The results also underline the importance of toric lenses as a strategic keystone in correcting high astigmatic keratometry after radial keratotomy