Refractive Rehabilitation In Patients With Previous Corneal Surgeries.

To rehabilitate the patients with previous corneal surgeries leaving the least possible amount of residual prescription and the best visual acuity without depending on the use of glasses or contact lenses through refractive surgery. 

Even after a successful corneal surgery, patients experience severe refractive errors, impeding their rehabilitation and satisfaction. 

Non surgical interventions such as spectacles and contact lenses fail to provide desirable vision in cases of high astigmatism and corneal irregularity.

When these limitations are encountered, we have the very good option of surgical interventions as refractive surgeries to be employed with very good visual results.

Retrospective review of 51 eyes operated previously in our center, 45 with previous PKP, 5 with corneal rings and one with crosslinking. 

Out of the 51 operated, 45 had phacoemulsification with implant of IQ Toric T3-T9 lenses (Alcon®) or AT Torbi M/MP lenses (Zeiss®), and 6 patients younger than 40 years had ICL Phakic lenses (Staar Surgical®). 

We Included patients with regular and moderate astigmatism after the removal of stitches 12-15 months after Penetrant Keratoplasty and 6 months after in the cases of Corneal Rings and Crosslinking. 

The primary Results included UCVA, CDVA and Manifest Spheric Refraction Equivalent (MSRE). 

The average last of follow up after refractive surgery was 18,9± standard deviation 13.8 months. 

There was a significant improvement of UCVA and CDVA since the first month post operatory until the end (p<0,001). 

The average of visual acuity with and without correction didn’t change significantly (p=0,68 and 0,74 respectively). 

The MSRE improved from 3.73± 1.92DP to 1,88± 1,06DP (p=<0,001) and it didn’t change along the time. 

Only 2 eyes (3.9%) had one episode of mild rejection at 2 and 4 months respectively that was solved fast and without consequences. 

The best visual acuity with correction CDVA was 20/40 or better in 96% of the eyes. 

The best visual acuity without correction UDVA was 20/40 or better in 51% of the eyes. 

It is possible to diminish the sphere and residual corneal astigmatism after PKP, corneal rings or crosslinking surgeries, with phacoemulsification and Toric intraocular lenses implant, or with phakic lenses in young patients, if they have moderate and regular astigmatisms after corneal surgeries, in order to avoid the use of contact lenses or even glasses, and to meet the broad demands of our patients nowadays.