Results Of A Non-Diffractive Wavefront-Shaping Extended Depth-Of-Focus Intraocular Lens In Cataract Surgery Of Patients With Previous Myopic Lasik Surgery

Nowadays more patients with cataracts have had a previous LASIK procedure, and with the cataract surgery they seek not only a good visual result but also a spectacle independence. However not all patients are good candidates for trifocal intraocular lenses (IOL) because of the halos and reduction of contrast sensitivity associated, and despite enhanced depth-of-focus (EDOF) IOLs could theoretically be a good option in these patients, it has not been published conclusive data. Therefore, the purpose of this study is to determine the efficacy and safety of cataract surgery with implantation of a non-diffractive wavefront-shaping EDOF IOL in patients with prior myopic laser assisted in-situ keratomileusis (LASIK).

Institut Català de Retina, Barcelona, Spain

Retrospective analysis of a case series of 49 eyes of 27 patients with previous myopic LASIK surgery who underwent to an uneventful cataract surgery with implantation of Vivity IOL (Alcon Laboratories).  Patients with other ocular pathologies such as glaucoma, retinal diseases, corneal opacities or dystrophies were discarded. A minimum follow-up of 3 months was considered. All the patients were studied preoperatively with corneal topography and optical biometry. The Barrett True K formulae was used in all cases for the IOL power calculation choosing the value closer to emmetropia. The manufacturer online calculator was used to determine the toricity and implantation axis of the IOL.

Mean age was 61 years-old (range 45 to 73) and mean previous LASIK correction -4,16 diopters (D) (range -2 to -10). Preoperative best corrected visual acuity (BCVA) was 0,74+/-0,22. Biometry showed a Km of 40,44D +/-1,47, a keratometric astigmatism of -0.75D+/-0,4 and a mean axial length of 25,8mm +/-1,03. Mean far postoperative uncorrected and BCVA were 0,84+/-0,19 and 0,98+/-0,07 respectively. Mean near postoperative uncorrected and BCVA visual acuity were J2,84+/-1,33 and J1,04+/-0,2 respectively. Mean postoperative spherical equivalent was -0,31+/-0,34, mean postoperative astigmatism was 0,3D+/-0,32 and 77,55% of the eyes were within +/-0,5D. None of the patients reported photic phenomena.

Vivity IOL achieves good visual results on cataract patients with previous myopic corneal refractive surgery. There is a mild trend to residual myopia using Barrett True K. Astigmatism correction is successfully achieved using IOL Master keratometry and estimation of posterior corneal astigmatism with Barrett formulae through the online calculator provided by the manufacturer. Although postoperative contrast sensitivity studies were not performed, none of the patients complained about visual quality symptoms, including photic phenomena. However, always a previous topographic examination regarding the features of the previous corneal laser surgery must be performed and the implantation of this kind of IOL has to be personalized.