Case Reports

Implantation of a pinhole implant for correction of residual refraction after cataract surgery and radial keratotomy

Case Report Details

First Author: H.Son GERMANY

Co Author(s):    R. Khoramnia   G. Auffarth                 

Abstract Details

Purpose:

Cataract surgery in patients who were previously treated with radial keratotomy can be challenging. In spite of cautious biometry and intraocular lens (IOL) power calculation, surgeons may be met with residual refraction postoperatively. In such cases, supplementary lenses can be implanted to achieve the optimal uncorrected distance visual acuity (UDVA). In this case report, we present the clinical outcomes after implantation of a pinhole sulcus implant (Xtrafocus, Morcher GmbH, Stuttgart, Germany) for correction of residual refraction after cataract surgery in a patient with a history of radial keratotomy.

Setting:

International Vision Correction Research Centre, University Eye Clinic Heidelberg, Germany

Report of Case:

A 62-year-old patient presented to our clinic with worsening vision on both eyes. He reported undergoing radial keratotomy 22 years ago to correct myopia (initially ca. -6.0 D). On right eye, UDVA was 0.6 logMAR and corrected distance visual acuity (CDVA) (+4.00/-2.00/82°) 0.4 logMAR, while on left eye, UDVA was 1.7 logMAR and CDVA (+7.50/-2.00/162°) 0.1 logMAR. The slit-lamp examination revealed 8 radial corneal incisions and corticonuclear cataract bilaterally. The anterior and posterior segments did not show any pathological findings. Cataract surgery was recommended and performed on both eyes with no intraoperative complications. The ASCRS IOL Calculator was used to calculate the appropriate IOL power. The monofocal TECNIS® PCB00 (Johnson&Johnson, Santa Ana, CA, USA) IOL with 29.0 D base power was implanted in both eyes. Postoperatively, the patient showed fluctuation in subjective refraction. On right eye, CDVA was (+1.00/-1.00/30°) 0.16 logMAR at 4-months, (+0.75/-1.00/70°) 0.1 logMAR at 7-months, (+2.00/-1.00/63°) 0.1 logMAR at 9-months, and (+0.75/-1.50/58°) 0.1 logMAR at 12-months postoperatively. On left eye, CDVA was (+1.50/-3.75/165°) 0.04 logMAR at 4-months, (+1.00/-1.00/30°) 0.1 logMAR at 7-months, (+1.75/-3.00/165°) 0.1 logMAR at 9-months, and (+1.00/-2.75/168°) 0.1 logMAR at 12-months postoperatively. To correct the fluctuating residual refraction, pinhole sulcus implant was implanted on the right eye. One month postoperatively, UDVA on right eye was 0.1 logMAR and the patient showed high satisfaction, good monocular contrast sensitivity as well as visual field results.

Conclusion/Take Home Message:

In cases of large residual refraction after cataract surgery in patients who were previously treated with radial keratotomy, the pinhole sulcus implant offers a good treatment option, providing high satisfaction rate, good UDVA, contrast sensitivity as well as visual field results.

Financial Disclosure:

None