Clear lens extraction with intraocular lens followed by photorefractive keratectomy or laser in situ keratomileusis

Objective: To study photorefractive keratectomy (PRK) or laser in situ kera tomileusis (LASIK) after clear lens extraction (CLE) with intraocular lens (IOL) implantation for hyperopia or astigmatism. Design: Retrospective, noncomparative interventional case series. Participants: Sixty-five eyes (55 subjects) had CLE with posterior chamber IOL implants for hyperopia up to 12.25 diopters (D); 31 eyes were retreated with PRK, and 34 eyes were retreated with LASIK for residual ametropias, Intervention: For PRK and LASIK, the refractive surgery was performed with the slit-scanning excimer laser Nidek EC-5000, Nidek Co., Tokyo, Japan. Main Outcome Measures: Manifest refraction, best-spectacle and uncorrected Snellen visual acuity, haze, and halos were evaluated before surgery and at 1, 3, 6, and 12 months postoperative. Results: Forty-seven eyes were evaluated at the 12-month postoperative exam ination: 96% of these eyes had spherical equivalents (SE) within +/-2 D of emmetropia, 79% of eyes had SE within +/-1 D of emmetropia and 51% of eyes had SE within +/-0.50 D of emmetropia. Eighty-five percent of the eyes at 1 2 months postoperative had uncorrected visual acuity of 20/40 or better, an d 46% of eyes had uncorrected visual acuity of 20/20 or better. Eighty-seve n percent of the eyes at 12 months postoperative had uncorrected visual acu ity within 1 Snellen line of their initial best spectacle-corrected visual acuity (BSCVA) before all treatment. No eye lost 2 Snellen lines of BSCVA a t 3, 6, or 12 months after PRK or after LASIK. Conclusions: IOL implantation for CLE, although an invasive technique, resu lted in better refractive outcomes without laser-related clinical complicat ions after PRK or LASIK adjustment. Ophthalmology 2001,108: 104-111 (C) 200 1 by the American Academy of Ophthalmology.