Correction of Residual Hyperopia After Cataract Surgery ... - Iogen

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TABLE 4. Accuracy of Sphere to Target – Hyperopic Corrections in Patients With Light Adjustable Intraocular Lens Technology Sphere One Day Post Lock-In refraction spherical equivalent presented in Table 5 demonstrating no significant change was induced on cylinder. ● STABILITY OF REFRACTIVE ADJUSTMENT: One hundred percent (14/14) of the eyes were stable within 0.25 D with 13 eyes showing no change at one to six months follow-up visits as compared with refraction at one day after lock-in treatment (Table 6). The mean rate of change was 0.006 D per month, which is six times more stable than that of refractive procedures. 19 ● STABILITY OF UNCORRECTED VISUAL ACUITY: All eyes demonstrated stability of uncorrected visual acuity (UCVA) after lock-in. The bar graph of UCVA before and after refractive adjustments is shown in Figure 3. The data demonstrated significant improvement in UCVA for 64% of the 14 eyes and the UCVA is stable for a follow-up period up to six months. Seventy-one percent (10/14) of eyes achieved UCVA of 20/25 or better. All eyes were 20/30 or better. The four eyes that did not achieve UCVA Three Months Postoperative Six Months Postoperative n/N % n/N % n/N % % within 0.25 D of attempted 13/14 92.9% 13/14 92.9% 8/9 88.9% % within 0.50 D of attempted 14/14 100.0% 14/14 100.0% 9/9 100.0% % within 1.0 D of attempted 14/14 100.0% 14/14 100.0% 9/9 100.0% D diopters. TABLE 5. Accuracy of Manifest Refraction Spherical Equivalent to Target – Hyperopic Corrections in Patients With Light Adjustable Intraocular Lens Technology MRSE One Day Post Lock-In Three Months Postoperative Six Months Postoperative n/N % n/N % n/N % % within 0.25 D of attempted 13/14 92.9% 13/14 92.9% 8/9 88.9% % within 0.50 D of attempted 14/14 100.0% 14/14 100.0% 9/9 100.0% % within 1.0 D of attempted 14/14 100.0% 14/14 100.0% 9/9 100.0% D diopter; MRSE manifest refraction spherical equivalent. TABLE 6. Stability of Refractive Adjustment in Patients With Light Adjustable Intraocular Lens Technology Change of Refraction (D) Number of Eyes Total 14 Follow-up Time (mos) 0 13 1–6 0.25 1 1–3 D diopters; mos months. of 20/25 or better had residual astigmatism that was not treated. ● STABILITY OF BEST-CORRECTED VISUAL ACUITY: BCVA before and after refractive adjustments is displayed in Figure 4. All 14 eyes were stable and able to maintain their preadjustment BCVA following refractive adjustment and lock-in treatments with follow-up time up to six months. ● COMPLICATIONS: Any adverse events or complications were recorded. In addition to typical adverse events associated with IOLs, we looked carefully for evidence of uveitis, UV keratopathy, elevated intraocular pressure, posterior capsular opacity, glare, and halos. There were no adverse events or complications reported. DISCUSSION HYPEROPIC REFRACTIVE ERROR AFTER CATARACT SURgery is particularly undesirable since affected patients have no clear uncorrected far point. Residual hyperopia is particularly common after corneal refractive procedures where preoperative keratometry measurements are unreliable. Despite a wide array of empirical formulas, IOL power remains difficult to predict in patients who develop cataracts after refractive surgery. Herein, we demonstrate feasibility of correcting residual hyperopic error after cataract surgery using the light adjustable lens technology. VOL. 147, NO. 3 PSEUDOPHAKIC HYPEROPIA CORRECTION 395
FIGURE 3. Bar graph of uncorrected visual acuity (UCVA) before and after hyperopic corrections in patients with light adjustable IOL technology. UCVA was expressed by converting the Snellen fraction to a numerical number, 20/20 1.0, 20/25 0.8, 20/30 0.67, 20/40 0.5, 20/50 0.4, 20/60 0.33, 20/80 0.25, and 20/100 0.2. Significant improvement in UCVA was observed in 64% of eyes. Of 14 eyes, 10 eyes (71%) achieved an UCVA of 20/25 or better. All eyes were 20/30 or better and stable for a follow-up period up to six months. FIGURE 4. Bar graph of best-corrected visual acuity (BCVA) before and after hyperopic corrections in patients with light adjustable IOL technology. BCVA was expressed by converting the Snellen fraction to a numerical number, 20/20 1.0, 20/25 0.8, 20/30 0.67, 20/40 0.5, 20/50 0.4, 20/60 0.33, 20/80 0.25, and 20/100 0.2. All eyes were stable and able to maintain their preadjustment BCVA. Correction of hyperopia between 0.25 to 2.0 D was achieved with 90% of patients corrected to within 0.25 D of the intended refraction. While this was a feasibility study and adjustments were performed in patients who had not had previous refractive surgery, it is likely that correction of hyperopia could be performed in a similar fashion in these patients as well. Uncorrected VA improved in 64% of patients while BCVAs was maintained after lock-in in all patients. The uncorrected and best-corrected VAs were stable for all patients up to six months follow-up visit. One hundred percent of the eyes were stable within 0.25 D with 13 eyes showing no change at one to six months follow-up visits. 396 AMERICAN JOURNAL OF OPHTHALMOLOGY MARCH 2009
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