Management Of Complex Post-Myopic Lasik Eyes With Exfoliation Syndrome With Spiral Non-Diffractive Iols: A Case Study

To evaluate the visual and refractive performance of the Rayner RayOne Galaxy spiral non-diffractive Full Range of Focus (FROF) intraocular lens (IOL) in a patient with multi-factorial surgical challenges: post-myopic LASIK corneal profiles and significant zonular instability secondary to Exfoliation Syndrome (XFS). The study aims to determine if this spiral optical design provides spectacle independence and maintains image quality despite altered corneal shapes and potential IOL decentration or tilt associated with XFS. Unlike diffractive lenses, the Galaxy design is theoretically more tolerant against minor tilt.

Private clinical practice.

A 60-year-old male with a ~25-year history of myopic LASIK presented with bilateral XFS-associated cataracts and a desire for complete spectacle independence. Preoperative assessment using high-resolution Scheimpflug tomography and aberrometry revealed altered corneal shapes. The RE had 0.03 microns of spherical aberration (SA) and 0.04 microns of coma. The dominant LE exhibited higher levels: 0.16 microns of SA and 0.34 microns of coma.

IOL power was calculated using the Barrett True-K Toric formula for post-refractive corneas to avoid hyperopic surprise. During surgery, the RE revealed 4 clock hours of zonular dialysis; a capsular tension ring (CTR) was implanted for stabilization before inserting a non-toric RayOne Galaxy (19.5 D). The LE underwent uneventful phacoemulsification with a toric RayOne Galaxy (20.0/2.25D).

One week postoperatively, UCVA reached 1.0 (decimal) and J1 near vision bilaterally. The result remained stable by 4 weeks after surgery. Despite the post-LASIK corneal profile, the patient reported perfect night vision with a total absence of dysphotopsia. The IOL remained well-centered in the RE despite the pre-existing zonular dialysis and XFS.

The RayOne Galaxy’s non-diffractive spiral design successfully provided a continuous range of focus and proved highly tolerant of increased HOAs and zonular instability. Unlike traditional diffractive lenses, this spiral optic avoids adding ring-based aberrations and is more robust against minor tilt, which is critical in XFS patients where subtle decentration can occur over time. This case demonstrates that excellent refractive outcomes and patient satisfaction are achievable in "worst-case scenario" eyes when combining advanced formulas like the Barrett True-K with stable capsular support and a sophisticated, tilt-tolerant optical design.