Cataract Post Supracor Presbyopia Refractive Surgery Is A Dilemma If Not Well Evaluated

A case of female patient 52 years old with bilateral nucleus cataract grade 2, cortical cataract grade 2 and Supracor presbyopia corneal refractive surgery was done for 7 years. Presented to me for cataract surgery.

Watany Eye Hospitals, Cairo, Egypt

During history taking, the patient reported that since Supracor surgery, the left eye had poorer visual quality and distance vision compared to the right eye, although cataract stages were similar in both eyes. IOL options were discussed according to corneal evaluation results. Comprehensive investigations were performed, including Pentacam, epithelial mapping, biometry using IOLMaster 700 (hyperopic version), IOL calculations using ESCRS and ASCRS post-refractive hyperopic formulas, ocular surface assessment, and OCT macula.

Based on the findings, trifocal IOL implantation was excluded due to differences in corneal spherical aberrations and Q values between both eyes. We therefore selected an aspheric monofocal IOL for the right eye and a spherical monofocal IOL for the left eye. A slightly more aggressive strategy was planned for the left eye to enhance near vision.

Postoperatively, UCDVA was 20/20 in the right eye and 20/30 in the left eye. The left eye provided superior reading vision, while binocularly UCDVA and UCNVA reached 20/20. Postoperative iTrace showed optimal visual quality in the right eye with normal HOA and good LDI. The left eye demonstrated higher HOA and lower LDI despite acceptable visual acuity, yet the patient remained satisfied. All pre- and postoperative investigations will be presented.

Cataract post Supracor presbyopia refractive surgery, is one of the difficult situation because not much published about this situation, so it should be properly investigated, patient counselling situation and option for management and proper IOL selection even when it is different optical design as in our case report to reach acceptable results for the patient.