Transcript Cataract Extraction with Pseudoaccomodating Intraocular

Cataract Extraction with
Pseudoaccommodating Intraocular Lens in
Patients with Previous Radial Keratotomy
Ross Bloomberg, MD
Niraj Shah, BS
William Martin, MD
University of Toledo Health Science
Campus
Ross Bloomberg, MD has no financial interest to disclose.
Niraj Shah has no financial interest to disclose.
William Martin, MD is a consultant to Alcon and AMO.
Background
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An increasing number of radial keratectomy (RK)
patients are reaching an age where cataracts are
becoming visually significant
Many previous RK patients desire spectacle
independence
RK induces a multifocal cornea and other higher order
aberrations1-3, so prior RK patients are poor candidates
for multifocal intraocular lenses
RK patients may tolerate pseudoaccommodating
intraocular lenses
Purpose
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To report the safety, efficacy, and patient
satisfaction of phacoemulsification with
implantation of a pseudoaccommodating
intraocular lens in patients with prior radial
keratotomy
Methods
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A retrospective chart review was performed on 15 eyes
of 8 patients with previous RK undergoing cataract
extraction using phacoemulsification
All procedures were performed by a single surgeon
(WGM) through a scleral tunnel incision with
implantation of a pseudoaccommodating intraocular
lens (Crystalens AT-50SE, Eyeonics, Aliso Viejo,
California, USA)
Methods
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Distance, intermediate, and near visual acuity
were measured at 1 day, 1 week, 1 month, and 3
months. Residual refractive error was measured
at 1 month and 3 months.
Patients were asked to complete follow up
satisfaction surveys. Subjective complaints at
follow up visits were noted.
Results
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Uncorrected vision 14/15 (93.3%) of eyes had distance
VA >20/40
Uncorrected vision 12/15 (80%) of eyes had
intermediate VA >20/40
Uncorrected vision 12/15 (80%) of eyes had near VA
J3 or better
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1 eye had VA of 20/80 at 1 month post op with manifest
refraction of +2.75 -0.50 x 90. After subsequent sulcus
placed piggyback IOL, 3 month post op from piggyback
DVA was 20/20, IVA was 20/20, and NVA was J3.
Visual Results
Patient Age
1
2
3
4
5
6
7
8
58
60
60
40
55
65
56
65
Sex RK incisions
OD
OS
M
8
8
F
4
4
F
8
8
M
8
8
M
4
4
F
8
8
F
4
4
M
8
8
1mDVAOD 1mDVAOS 1moIVAOD 1moIVAOS 1moNVAOD 1moNVAOS
20/40
20/20
20/20
20/30
20/20
20/20
20/80
20/25
20/40
20/25-2
20/30+
20/30+2
20/40
no data
20/25
20/25
20/20+
20/2020/20
20/16
20/100
20/25
20/200
20/125
20/20+
20/25
20/30
20/16
20/40
no data
20/40
20/16
J2
J5
J1+
J1
j10
J1
<J10
J1
J2
J3
J2
J1
J6
no data
J2
J2
Results
Satisfaction (scale
of 1 to 10)
Patient Satisfaction with
Pseudoaccommodating IOL after
RK
10
8
6
4
2
0
Near
Intermediate
Distance
1 2 3 4 5 6 7 8
Patient (no survey from
patient 2 or 6)
Results – Spectacle Dependence
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Percentage of time wearing spectacles
Patient 1 – 0%
 Patient 2 – did not reply
 Patient 3 – 0%
 Patient 4 – 10%
 Patient 5 – 10%
 Patient 6 – did not reply
 Patient 7 – 30%
 Patient 8 – 0%
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Results
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5/5 (100%) of patients stated they would make the same choice
for their eyes again
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One patient who completed the survey did not answer this question
3/6 (50%) of patients rated glare symptoms as >3/10
2/6 (33%) of patients rated halo symptoms as >3/10
1 patient complained of monocular diplopia at distance
1 patient noted blurred vision in the morning that improved
through the day
2/8 patients did not complete the survey
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one patient could not be reached
one patient refused survey stating they were unhappy with the experience,
but did not elaborate
Conclusions
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Pseudoaccommodating IOLs can be well tolerated in post-RK
patients
Pseudoaccommodating IOLs can allow for spectacle
independence in post RK patients
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Multifocal cornea may contribute to spectacle independence1-3
Post op complaints were consistent with prior RK (glare, halos,
monocular diplopia, diurnal fluctuation, error in IOL
calculation)4-11
Glare
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14/16 eyes in this study had glare 20/70 or worse preop (BAT or MCT)
Post op significant glare complaints are comparable to those in PERK
study
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225/425 (52.9%) patients in the Prospective Evaluation of Radial
Keratotomy (PERK) study reported glare with bright lights4
References
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keratotomy. Cornea. 1992 Sep;11(5):465-70.
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Surg. 1989 Nov-Dec;5(6):394-9.
3. McDonnell PJ, Garbus J, Lopez PF. Topographic analysis and visual acuity after radial keratotomy. Am J
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