RESULTS OF INTRAOCULAR LENS IMPLANTATION IN PATIENT AFTER LASER VISION CORRECTION

To evaluate the refractive outcomes, accuracy, and predictability of intraocular lens (IOL) implantation in patients with a history of corneal laser refractive surgery.

The study was conducted at iClinic s.r.o., Ophthalmology Clinic, Bratislava, Slovakia — a tertiary referral center specializing in cataract, refractive, and corneal surgery. The research was carried out from March 2024 to October 2025. All procedures were performed by the same experienced surgeon under standardized operative conditions.

A retrospective observational study was conducted on patients who underwent phacoemulsification and IOL implantation following previous corneal refractive procedures, including PRK, LASEK, LASIK, and ReLEx SMILE.
Preoperative evaluation included corneal topography, anterior segment optical coherence tomography (AS-OCT), corneal tomography with the Pentacam AXL, and optical biometry using the IOLMaster 700.
IOL power was calculated using several formulas specifically designed for post-refractive eyes: Barrett True-K, Pearl DGS, Haigis-L, EVO, and DUDO Software. The target refraction in all cases was emmetropia. Postoperative refraction was assessed at one and three months after surgery. The refractive prediction error (RPE) was defined as the difference between the achieved and target refraction.

The mean refractive prediction error across all cases was -0.37 diopters (D). In 78% of eyes, postoperative refraction was within -0.25 D of the target, and in 22% — within -0.50 D.
The lowest mean absolute error and the highest refractive stability were observed with the DUDO Software and Barrett True-K formulas. This accuracy was attributed to the use of corneal topography data and preoperative refractive history, which improved the estimation of the effective lens position. The Pearl DGS and EVO formulas also demonstrated good agreement, though with slightly higher variance.

Accurate IOL power calculation in post-refractive eyes remains a clinical challenge. The use of specialized post-refractive formulas — particularly Barrett True-K and DUDO Software — significantly enhances refractive predictability and stability. Integrating corneal tomography data and preoperative refractive history into the calculation process is essential for achieving optimal visual outcomes in this complex group of patients.