Management of cataract in post-LASIK patients

Session Details

Session Title: Cataract Surgery Special Cases II

Session Date/Time: Monday 15/09/2014 | 16:30-18:30

Paper Time: 16:42

Venue: Auditorium

First Author: : S.Shaligram INDIA

Co Author(s): :    M. Kummelil   R. Shetty   S. Das   V. Arora     

Abstract Details

Purpose:

To present an algorithm for management of patients with cataract who have undergone LASIK in the past

Setting:

Tertiary Eye Care Centre and Teaching Institute in South India

Methods:

9 eyes of 7 patients with cataract who had undergone LASIK in the past were included in this study. All patients underwent a complete ophthalmological evaluation. Topography with Pentacam and aberrometry with iTrace was performed. On the basis of this , they were divided into three groups Group 1- 3 eyes of 2 patients with regular corneas with normal Higher order Aberrations (HOA) who underwent cataract surgery after calculating IOL power using ASCRS calculator Group 2- 4 eyes of 3 patients with decentered ablations , small optical zones, high HOA’s underwent a topoguided excimer laser ablation using (T-CAT) software to correct corneal irregularity. Cataract surgery was perfomed following stabilisation of the keratometry, IOL power calculated using ASCRS Calculator. Group 3- 2 eyes of 2 patients with decentered ablation’s , high HOA’s needing correction of corneal irregularity , but since the residual stroma was inadequate, cataract surgery was performed with IOL power calculate using ASCRS calculator

Results:

Conventionally, cataract surgery has been followed by surface treatment but topo-guided ablation will induce some amount of HOA’s which if left untreated will give rise to poor quality of vision and when treated will induce some amount of refractive error so the target of emmetropia post cataract surgery will not be acheived. So our approach involved topo-guided ablation followed by cataract surgery In the group in whome topo guided ablation of the cornea was performed, the Best corrected visual acuity was 0.43±0.29 (logMAR) preoperatively and improved to 0.13±0.25 after cataract surgery. The corneal spherical aberrations decreased from 0.279±0.357µ pre operatively, to 0.082±0.193µ after cataract surgery (P=0.039). The internal aberrations also decreased significantly from 1.210±1.166µ preoperatively to 0.416±0.495 µ (P=0.039). There was reduction in corneal higher order aberrations preoperatively, from 0.641±0.484µ to 0.309±0.219µ postoperatively (P=0.368). Improvement was noted for total higher order aberrations, which decreased from 0.791±0.431 µ preoperatively to 0.398±0.551µ (P=0.174). There was improvement in point spread function and modulation transfer function postoperatively but it did not reach level of significance (both P > 0.05).

Conclusions:

Management of cataract in post lasik patients needs to be customised for each patient as patients with decentered ablations, small optical zones, high aberrations will have poor quality of vision if managed like a routine catarct surgery and these are the type of patients who will have high expectations of the outcome. Topoguided ablation of post-LASIK irregular corneas prior to cataract surgery can yield good results with overall reduction in higher order aberrations. The future is going to be a lot of patients like these , presenting with cataract having undergone LASIK in the past , so one needs to have a tailor made approach for these patients depending on their corneal topography and aberration profile

Financial Interest:

NONE