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D. Mutyala, N. Menon, L. Padnick-Silver, M. Macsai; LASIK Enhancement for Residual Ametropia after Accommodating Intraocular Lens Implantation. Invest. Ophthalmol. Vis. Sci. 2009;50(13):585.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the efficacy of laser in situ keratomileusis (LASIK) in correcting refractive error after cataract extraction (CE) and accommodating intraocular lens (IOL) implantation. Preoperative characteristics of patients that underwent LASIK were also examined.
A single-center nonrandomized retrospective study of 72 eyes that underwent CE/IOL implantation of a Crystalens AT-45 (Eyeonics, Aliso Viejo, CA) between Jan ‘04 and April ’08. During surgical planning, the refractive target was emmetopia. All surgical procedures were performed by one surgeon (MM). Seven eyes did not have full visual potential due to other pre-operative conditions and were excluded from the analysis. Of the 65 eyes included, 12 underwent LASIK to correct for residual refractive error after CE/IOL. Visual acuity data were converted to LogMAR for analysis and presented as Snellen visual acuities as per convention. Data are presented as mean ± standard deviation. Means were compared between groups with unpaired t-tests. Statistical significance was defined as p≤0.05.
The mean interval between cataract surgery and LASIK was 6.3 ± 6.8 months. Following CE/IOL, there was no statistical difference between best-spectacle corrected distance visual acuity (BSCVA) of patients that did not have LASIK (0.03±0.07; ~20/20, n = 53 eyes) and the uncorrected distance visual acuity (UCDVA) of patients that did have LASIK (0.07±0.10; Snellen ~20/25, n = 12 eyes) (p = 0.14). Interestingly, patients who chose to have post-CE/IOL LASIK had steeper corneas (K = 44.93 ±1.40 D vs. K = 43.35 ±1.42 D; p<0.001) and better pre-CE UCDVA (0.64±0.69, ~ 20/80 vs. 1.32±0.65, ~ 20/400; p<0.01) than patients who chose not to have an enhancement. They also had worse UCDVA after CE/IOL (0.52±0.31, ~20/60 vs. 0.21±0.32, ~20/33; p=<0.01), and higher visual potential (BSCVA: -0.01±0.36, ~20/20 vs. 0.34±0.67, <20/20; p=0.03).
LASIK is as effective in correcting for residual refractive error as spectacles in patients with the Crystalens AT-45 IOL. Since the advent of accomodating IOLs, their use has become widespread in the ophthalmic community and learning more about the successes and failures of LASIK to treat residual ametropia is of value. Additionally, knowing which patients may choose to have LASIK after receiving the Crystalens could be useful while counseling patients.
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