Refractive correction with multifocal intraocular lenses after radial keratotomy

• Published in: Eye (London) 2019-06, Vol.33 (6), p.1000-1007
• Main Authors: Martín-Escuer, Bárbara, Alfonso, José F., Fernández-Vega-Cueto, Luis, Domíngez-Vicent, Alberto, Montés-Micó, Robert
• Format: Article
• Language: English
• Subjects: 692/308/409; 692/700/1518; 706/648/160; Acuity; Adult; Aged; Cataracts; Eye; Female; Follow-Up Studies; Humans; Intraocular lenses; Keratotomy, Radial - methods; Laboratory Medicine; Lens Implantation, Intraocular - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Multifocal Intraocular Lenses; Myopia - etiology; Myopia - physiopathology; Myopia - surgery; Ophthalmology; Phacoemulsification - adverse effects; Pharmaceutical Sciences/Technology; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Prosthesis Design; Refraction, Ocular - physiology; Reoperation; Retrospective Studies; Surgery; Surgical Oncology; Treatment Outcome; Visual Acuity
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/s41433-019-0364-8

Purpose To assess visual and refractive results of multifocal intraocular lens (IOLs) implantation for refractive correction after radial keratotomy (RK). Methods In a retrospective non-comparative interventional case series, we analyzed the outcomes of multifocal IOL implantation performed in the context of cataract or refractive lens exchange surgery following RK. A total of 17 eyes from nine patients were included in the study. IOL power calculation was done using the Double-K formula. Refractive error was used to assess predictability, and distance-corrected visual acuity (DCVA) and uncorrected distance visual acuity (UDVA) values were used to assess the surgical procedure’s efficacy and safety. Distance-corrected near visual acuity (DCNVA) was also determined. Results Phacoemulsification and multifocal IOL implantation was successful in all cases, with neither complications nor adverse events. At 6 months postoperatively, monocular UDVA, DCVA, and DCNVA were 0.51 ± 0.39, 0.20 ± 0.30, and 0.11 ± 0.11, respectively (logMAR scale). More specifically, 35.29% of the eyes had DCVA ≥20/20 and 52.94% showed DCVA ≥20/25. Regarding pre- vs. post-operative changes, 52.94% had lost one line of DCVA, 23.53% showed no changes, 11.76% had gained one line of DCVA, 5.88% had gained two lines, and 5.88% had gained three or more lines. The efficacy and safety indexes were 0.56 and 0.98, respectively. As for near vision surgical outcomes, 29.41% of the eyes had DCNVA ≥20/20 and 64.71% had DCNVA ≥20/25. As for surgical accuracy, 29% of the eyes were within ±0.50 D of the target refraction, whereas 65% were within ±1.00 D. Conclusions Multifocal IOL implantation following radial keratotomy (RK) does not result in good distance visual performance, at least after 6 months of follow-up. Thus, this surgical approach has to be considered with only limited expectations.