First Author: R.Khoramnia GERMANY
Co Author(s): G. Auffarth T. Rabsilber M. Holzer
Purpose:
The power calculation of intraocular lenses (IOL) in eyes after refractive surgery can be very challenging. The changes of the corneal radii and keratometer index as well as the inaccurate prediction of the IOL position postoperatively using different formulas were determined as error sources which can lead to an inaccurate IOL power calculation. Because patients with previous Excimer laser corneal surgery are used to being spectacle independent, they often desire a solution that provides both distance and near vision when they develop presbyopia or cataract. However, when multifocal IOLs are implanted in an eye with previous Excimer laser corneal surgery, accuracy of the IOL power calculation is extremely crucial in order to achieve emmetropia after surgery and thus patients satisfaction.
Setting:
International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
Methods:
We report on a 66 year old patient who presented with increasing hyperopia, astigmatism and presbyopia in both eyes aiming for spectacle independence. The patient had undergone LASIK in both eyes (OD/OS) eight years before. Three months later, LASIK-Enhancement had been performed on the left eye (OS) because of a residual refractive error. When we first saw the patient, the subjective refraction was +2.25/-1.25/135° (OD) and +1.25/-1.0/40° (OS). The cycloplegic refraction was +2.5/-1.25/115° (OD) and +1.75/-1.25/35° (OS). Bilateral multifocal, toric intraocular lenses with an embedded +3.0 D near segment and individually customized cylinder correction (Lentis Mplus LU-313 MF30T) were implanted uneventfully following phacoemulsification. The Haigis-L formula after previous hyperopia correction was chosen for IOL power calculation.
Results:
The Haigis-L formula provided reliable results. Emmetropia was targeted and achieved. Uncorrected distance visual acuity (UDVA) increased from 0.40 logMAR before to 0.10 logMAR three months after surgery (OD) and from 0.20 logMAR to 0.00 logMAR (OS), respectively. The patient gained six lines of uncorrected near visual acuity (UNVA) with 0.20 logMAR (OD) and 0.10 logMAR (OS) after surgery. Binocular UDVA was 0.00 logMAR and binocular UNVA was 0.10 logMAR. The IOLs were well centered in both eyes. The patient was very satisfied with his vision in the distance and near and did not report any halos or glare.
Conclusions:
Our case report shows that even in such challenging cases customized Premium IOL implantation is possible using the Haigis-L formula providing accurate results and spectacle independence. FINANCIAL DISCLOSURE?: ... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, ... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented
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