INTRAOCULAR LENS IMPLANTATION AND PATIENT SATISFACTION AFTER PRESBYMAX LASIK (CASE DESCRIPTION)

To evaluate visual and optical outcomes after intraocular lens (IOL) implantation in post-PresbyMAX® eyes, comparing multifocal and aberration-neutral aspheric designs in relation to residual corneal aberrations.

Experimental Eye Research Institute, University Eye Hospital, Ruhr-University Bochum, Germany, and Sphere Eye Clinic, Moscow, Russian Federation.

Two patients with prior PresbyMAX® who developed age-related lens opacities underwent refractive lens exchange (RLE). IOL power was calculated using the Barrett True-K formula, optimized for post-refractive eyes. Pre- and postoperative distance, intermediate, and near visual acuity (NCVA, BCVA, UNVA), near addition, spherical aberration (SA) at 7-mm pupil and subjective visual satisfaction were assessed. Follow-up was conducted one week after surgery. 
Case 1 A 60-year-old patient presented 12 years after PresbyMAX® with UCVA (OD 0.3; OS 0.6) (BCVA 1,0) complaining on limited near vision (UNVA 0.1 in both eyes). Preoperative SA was +0.07 µm (OD) and –0.01 µm (OS) which is lower as planned. Following implantation of a rotationally asymmetric, refractive, multifocal IOL with a sector-shaped near segment, UCVA improved to 1.0 bilaterally and binocularly. UNVA increased to 0.5 (OD/OS) and 0.6 binocularly. The patient reported excellent visual comfort and complete spectacle independence within one week. 
Case 2 A 62-year-old patient, who had PresbyMAX® treatment 11 years ago developed bilateral cataract. Preoperative findings included NCVA 0.3 (OD) and 0.9 (OS), BCVA 0.6 (OD; sph–1.0 D) and 1.0 (OS; sph –0.75 D), with SA of –0.60 Deq (OD) and –0.23 Deq (OS). After implantation of an aspheric, aberration-neutral monofocal lens, BCVA reached 1.0 in both eyes, NCVA improved to 0.5 (OD), 0.7 (OS), and 0.8 binocularly. Near vision reached UNVA 0.9 (OD), 0.4 (OS), and 1.0 binocularly. The patient reported excellent visual comfort and complete spectacle independence within one week.

After PresbyMAX®, both multifocal and aberration-neutral aspheric IOLs can achieve favorable functional and optical outcomes. IOL selection should be individualized according to the clinical presentation, patient’s visual demands, and corneal aberration profile.