A Double Trouble!: Cataract Surgery After Double Refractive Surgery.

To discuss the planning of IOL power calculation in a Post LASIK and post-phakic IOL eye.

The study was done in a tertiary care center in India 

A 40 yr old High myope with a history of BE LASIK surgery 20 yrs ago followed by Right ICL 5 yrs ago presented with Significant anterior subcapsular cataract (ASC) in the right eye. Our paper describes the lens power calculation in a case with bioptic refractive surgery and the challenges involved in the setting of an abnormally long eye (34.42mm).

Best corrected Visual acuity was 6/60 in the right eye with -4.5-DS and -2DC at 120 and 6/9 with -4DS in the left eye. The right eye showed an ASC. The posterior segment in the right eye showed a Full-thickness macular hole, and the left eye showed a tesselated fundus. The axial length in the right eye was 34.42 mm, and the left eye was 28.21mm. Biometry with IOL master 700 with Phakic IOL mode and Barrett Universal true K formula and applying Wang Koch optimization for high axial length, +8 D IOL was planned. He underwent Right ICL explant with cataract surgery.

Cataract is a frequent complication of PIOL implantation. Many modifications have been done for biometry calculation after LASIK or ICL surgeries. However, the difficulties in calculating IOL power after both LASIK and ICL placement make it further challenging. The anterior surface of the phakic-IOL is mistakenly recognized as the crystalline lens, leading to an underestimation of ACD and an overestimation of LT. All these difficulties can give a post-op hyperopic surprise. Hence, careful planning and a customized approach in calculating IOL power is essential for optimum results in such cases.