Excimer laser surgery for correction of ametropia after cataract surgery
Accepted 14 January 2005.
Purpose
To review the cases of patients who had excimer laser refractive surgery to correct unintentional or undesired ametropia after cataract extraction with intraocular lens (IOL) implantation.
Setting
Wilmer Laser Vision Correction Center, Wilmer Eye Institute, Baltimore, Maryland, USA.
Methods
In this retrospective noncomparative review of consecutive cases, the Wilmer Laser Vision Correction Center's database was searched for patients who had laser in situ keratomileusis or photorefractive keratectomy to correct ametropia after cataract extraction with IOL implantation.
Results
Using the Visx Star excimer laser system (Visx, Inc.), 11 procedures were performed in 11 eyes of 10 patients a mean of 47 months (range 2 to 216 months) after cataract extraction with IOL implantation. Except for 1 patient with a silicone plate lens, all patients received 3-piece poly(methyl methacrylate) lenses. The mean age at time of excimer treatment was 75 years (range 70 to 81 years). Before laser surgery, the mean spherical equivalent of patient eyes was −3.76 diopters (D) ± 2.50 (SD) (range −6.50 to +0.75 D), spherical refraction ranged from −9.00 D to plano, and the highest cylindrical refraction was +5.50 D. At last follow-up (mean 12.2 months; range 1 to 38 months), the mean manifest spherical equivalent was −0.88 ± 1.43 D (range −2.75 to +2.13 D). Changes in mean manifest spherical equivalent were highly significant (P = .03, Wilcoxon signed rank test for paired values). There was no difference between targeted and achieved postoperative refraction (P = .34, Wilcoxon test). Increasing age was correlated with a hyperopic shift (r = 0.525, P = .05). All patients were satisfied with their final uncorrected visual acuity (UCVA), which improved in every case. Except for 1 patient in whom an epiretinal membrane developed, best spectacle-corrected visual acuity remained unchanged or improved.
Conclusions
In this series of patients, who were a few decades older than the typical excimer laser candidate, laser refractive surgery was a safe, effective, and predictable method to correct ametropia after cataract extraction with IOL implantation. It may be a viable, noninvasive alternative to intraocular surgery, which has potential complications. Although satisfactory for all patients, final UCVA was not as high as that reported in laser refractive surgery patients in general, and this result may be because of prior cataract extraction with IOL implantation or increased age.
From the Wilmer Eye Institute, Baltimore, Maryland, USA
Reprint requests to Irene C. Kuo, MD, Wilmer Eye Institute, 4924 Campbell Boulevard, #100 Baltimore, Maryland 21236, USA.
Presented at the ASCRS Symposium on Cataract, IOL and Refractive Surgery, Washington, DC, USA, April 2005.
Supported by an unrestricted grant from Research to Prevent Blindness, New York, New York, USA.
Dr. Jabbur and Dr. O'Brien have received honoraria and travel reimbursements from Visx, Inc., Santa Clara, California. Dr. O'Brien is a consultant/advisor for Bausch & Lomb. Dr. Jabbur is an ad hoc consultant and clinical investigator for Visx, Inc. No other author has a financial or proprietary interest in any material or method mentioned.
ABSTRACT