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Cataract Surgery | Nov/Dec 2011

Case Study:The LAL in a Postrefractive Surgery Patient

The Light Adjustable Lens improved vision 15 years after radial keratotomy.

Current ophthalmic technologies allow us to perform vision-correcting surgeries within minutes and without major complications. Some of these same improvements, however, give rise to new surgical challenges. For example, even with use of a femtosecond laser, residual astigmatism or other defects can spoil the most perfectly executed surgery. Additionally, performing cataract surgery in an eye after corneal refractive surgery is difficult because of the surgery’s influence on preoperative biometric calculations. This can lead to unpredictable results after cataract surgery if the wrong IOL power is chosen.

Current ophthalmic technologies allow us to perform vision-correcting surgeries within minutes and without major complications. Some of these same improvements, however, give rise to new surgical challenges. For example, even with use of a femtosecond laser, residual astigmatism or other defects can spoil the most perfectly executed surgery. Additionally, performing cataract surgery in an eye after corneal refractive surgery is difficult because of the surgery’s influence on preoperative biometric calculations. This can lead to unpredictable results after cataract surgery if the wrong IOL power is chosen.

CASE STUDY

A 48-year-old woman began to experience bilateral vision loss 15 years after refractive surgery for the treatment of 12.00 D of myopia in each eye. When she presented for cataract surgery assessment, her UCVA was Snellen decimal 0.2 and 0.3 in the right and left eyes, respectively, and her BCVA was 0.3+ in both eyes. Her refraction was +2.25 -3.25 X 103° in the right eye and -1.75 +1.75 X 47° in the left. The patient did not wear glasses because, as she reported, her vision was poor with or without them.

Biomicroscopy revealed that radial keratotomy had previously been performed in both eyes. There were grade 2 (on a scale of 0 to 5) nuclear cataracts in both eyes. Because previous data was not available, effective corneal power was measured using a contact lens. For the biometric calculation, a keratometry reading of 38.17 was used in the right eye and 34.62 in the left.

I decided to implant the LAL in each eye, selecting powers of 21.00 and 17.00 D for the right and left eyes, respectively. At the patient’s first postoperative follow-up, UCVA in her right and left eyes was 0.3 and 0.2, respectively; BCVA was 0.3 and 0.7, respectively. At the 3-week followup after lens implantation, I adjusted the refractive power of the lens. After this adjustment, the patient’s UCVA improved to 0.5 in both eyes, and her BCVA improved to 0.8 and 0.7 in her right and left eyes, respectively. I performed a second UV-adjustment to further improve the result before locking in the effective lens power. The end result was a remarkable improvement in the patient’s visual and refractive results (Table 1).

CONCLUSION

This case study is just one example of the results I have had with the LAL. After implanting this lens for more than 1 year, I can confidently say that results have been promising in all 27 patients who received the lens. Adjustability of the lens power is effective, even after previous refractive surgery (refraction within ±0.50 D of target). I consider the LAL to be the best IOL option for patients with cataract after corneal refractive surgery. What attracts me most to this technology is the potential future possibility of correcting higher-order aberrations and improving near vision even after the lens has been implanted.

Julián Cezón, MD, is the Medical Director of the Clínica CIMO de Sevilla, Spain. Dr. Cezón states that he has no financial interest in the products or companies mentioned. He may be reached at email: drcezon@cimo.es.

TAKE-HOME MESSAGE

  • With the LAL, IOLpower can be corrected after lens implantation using a photopolymerization process to change the lens’ power in situ.
  • This strategy can eliminate the need for futher correction, such as corrective lenses or enhancement procedures.

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