Managing Presbyopia In A High Myope Post Phacic Implant Induced Cataract

Many patients that had Phacic implants can present with cataracts much later. High myopes who had high errors that require cataract surgery may desire complete spectacle independence, including for reading. Trifocal and full range vision lenses are not available in low diopters and monovision may not be an option. I came up with a solution for these patients that were previously minus 15 or more. For emmetropia they often require 5 diopters or less in IOL replacement. These are not available in trifocal.

Tygervalley Eye and Laser Clinic , Cape Town. South Africa

A 43 year old patient had Staar ICL implants in both eyes 15 years ago done by myself. The surgery initially was uncomplicated.

Recently the patient presented to me with a grade 3 nuclear cataract that required cataract surgery. His uncorrected vision in his right eye was 20/20. In his left eye his uncorrected vision was 20/50 and best corrected 20/40. The surgery was discussed with the patient. He wanted to not lose ability to read with eye but want good distance vision as well.

The IOL calculation was done and calculated a 5 diopter IOL. His axial  length was 29. He did not favour monovision. A flacs procedure was done with the ICL in situ. The ICL was removed uneventfully and a phaco was done. A 5 diopter monofocal Alcon  IOL was implanted . An add-0n plano multifocal add-on lens was implanted in the same setting ( Dual Lens implantation) into the sulcus , on top of the primary IOL.  This avoids the "Red-Rock" syndrome intislly described by Ron Stasiuk from Melbourne in the mid 90's. 

The procedure was uncomplicated and the resutt was that the patient had 20/20 vision uncorrected and J1 for near. Very happy patient. 

A video is presented to show the technique.

Refractive surgery patients often have high demands , having been spoilt with good vision. When they are much older or develop phacic lens induced cataracts they want clear visin for distance and reading. In these high myopic cases mulrifocal IOLs are not always available in the low diopters. A dual lens implatn provides a highly successful safe management tool in these cases . It can also be easily removed if needed.