IOL Calculation in a Previous Refractive Hyperopic Patient
A 48-year-old female presented complaining of a decrease in her visual acuity for distance and near since 6 months ago. The patient had undergone uncomplicated bilateral simultaneous laser-assisted in situ keratomileusis (LASIK) for the correction of hype
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IOL Calculation in a Previous Refractive Hyperopic Patient Jorge L. Alió and Felipe A. Soria
Contents Why Is This Case Relevant for the Refractive Surgeon? ..................................
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Case Background ...................................................
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Main Problem to Solve ..........................................
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Ancillary Tests ........................................................
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Surgical/Medical Intervention ..............................
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Outcome ..................................................................
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What to Learn from This Case .............................
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References ...............................................................
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A 48-year-old female presented complaining of a decrease in her visual acuity for distance and near since 6 months ago. The patient had undergone uncomplicated bilateral simultaneous laserassisted in situ keratomileusis (LASIK) for the correction of hyperopia 15 years prior. Visual complaints were attributed to the regression of hyperopia and cataract, so cataract extraction was planned. Pre-LASIK refractive data was available.
Why Is This Case Relevant for the Refractive Surgeon?
J.L. Alió, MD, PhD (*) Department of Refractive Surgery, Vissum Corporación Oftalmológica, Alicante, Spain e-mail: [email protected] F.A. Soria, MD Department of Refractive Surgery, Instituto de la Visión, Universidad de Montemorelos, Montemorelos, Mexico e-mail: [email protected]
The challenge of IOL calculation and the optical quality of an already treated cornea, which IOL to select. We find two relevant aspects to analyze: 1. LASIK treatment in high hyperopes and the induced aberrations due to centration [1]. In the following study [2], an acceptable predictability for the treatment of high levels of hyperopia (>4 D of spherical equivalent) with a laser platform with a 500 Hz repetition rate and 1,050 Hz eye tracker as well as the use of optimized aberration-free ablation profiles after a 6-month follow-up was found. This technique is still effective (index 0.85) and should be considered acceptable for correcting hyperopia up to +8.50 D. Regression in hyperopes is well documented; some studies have
J.L. Alió et al. (eds.), Difficult and Complicated Cases in Refractive Surgery, DOI 10.1007/978-3-642-55238-0_4, © Springer-Verlag Berlin Heidelberg 2015
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J.L. Alió and F.A. Soria
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found an average increase in hyperopia of +0.54 D over a 5-year follow-up. 2. IOL calculation in a previous refractive hyperopic patient. We are starting to perform cataract surgery in the first wave of patients with previous refractive surgery. The “tsunami” of these patients is near, and knowing all the previous history data of each patient will help us to offer them, for a second time, the possibility of emmetropia. In the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO), the recommended refractive outcome should be an absolute mean biometry prediction error of 0.6 D or less. A biometry error with a correct sign
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