Abstract
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.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Fyodorov SN, Durnev VV. Anterior keratotomy method application with the purpose of surgical correction of myopia. In: Fyodorov SN, editor. Pressing problems of ophthalmosurgery. Moscow: Moscow Research Institute of Ocular Microsurgery; 1977. p. 47–8.
Waring GO 3rd, Lynn MJ, McDonnell PJ, PERK Study Group. Results of the prospective evaluation of radial keratotomy (PERK) study 10 years after surgery. Arch Ophthalmol. 1994;112:1298–308.
Duffey RJ, Leaming D. US trends in refractive surgery: 2002 ISRS survey. J Refract Surg. 2003;19:357–63.
Koch D, Liu J, Hyde L, Rock R, Emery J. Refractive complications of cataract surgery after radial keratotomy. Am J Ophthalmol. 1989;108:676–82.
Awwad S, Dwarakanathan S, Bowman R, Cavanagh H, Verity S, Mootha V, et al. Intraocular lens power calculation after radial keratotomy: estimating the refractive corneal power. J Cataract Refract Surg. 2007;33:1045–50.
Ma JX, TM, Wang L, Weikert MP, Huang D, Koch DD. Comparison of newer IOL power calculation methods for eyes with previous radial keratotomy. Invest Ophthalmol Vis Sci. 2016;57:162–8.
Zhang J, Liu X, Wang J, Xiong Y, Li J, Li X, et al. Outcomes of phacoemulsification using different size of clear corneal incision in eyes with previous radial keratotomy. PLoS ONE. 2016;11:e0165474.
Gupta I, Oakey Z, Ahmed F, Ambati B. Spectacle independence after cataract extraction in post-radial keratotomy patients using hybrid monovision with ReSTOR(®) multifocal and TECNIS(®) monofocal intraocular lenses. Case Rep Ophthalmol. 2014;5:157–61.
Kim K, Seok K, Kim W. Multifocal intraocular lens results in correcting presbyopia in eyes after radial keratotomy. Eye Contact Lens. 2017;43:e22–e25.
Nuzzi R, Monteu F, Tridico F. Implantation of a multifocal toric intraocular lens after radial keratotomy and cross-linking with hyperopia and astigmatism residues: a case report. Case Rep Ophthalmol. 2017;8:440–5.
Aramberri J. Intraocular lens power calculation after corneal refractive surgery: double-K method. J Cataract Refract Surg. 2003;29:2063–8.
Wilkins MR, Allan BD, Rubin GS, Findl O, Hollick EJ, Bunce C, Study Group. et al. Randomized trial of multifocal intraocular lenses versus monovision after bilateral cataract surgery. Ophthalmology. 2013;120:2449–.e1.
de Silva SR, Evans JR, Kirthi V, Ziaei M, Leyland M. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database Syst Rev. 2016;12:CD003169.
Applegate RA, Howland HC, Sharp RP, Cottingham AJ, Yee RW. Corneal aberrations and visual performance after radial keratotomy. J Refract Surg. 1998;14:397–407.
Kemp JR, Martinez CE, Klyce SD, Coorpender SJ, McDonald MB, Lucci L, et al. Diurnal fluctuations in corneal topography 10 years after radial keratotomy in the Prospective Evaluation of Radial Keratotomy Study. J Cataract Refract Surg. 1999;25:904–10.
Elbaz U, Yeung SN, Ziai S, Lichtinger AD, Zauberman NA, Goldich Y, et al. Collagen crosslinking after radial keratotomy. Cornea. 2014;33:131–6.
Maguire LJ, Bourne WM. A multifocal lens effect as a complication of radial keratotomy. Refract Corneal Surg. 1989;5:394–9.
Moreira H, Garbus JJ, Lee M, Fasano A, McDonnell PJ. Multifocal corneal topographic changes after radial keratotomy. Ophthalmic Surg. 1992;23:85–9.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Martín-Escuer, B., Alfonso, J.F., Fernández-Vega-Cueto, L. et al. Refractive correction with multifocal intraocular lenses after radial keratotomy. Eye 33, 1000–1007 (2019). https://doi.org/10.1038/s41433-019-0364-8
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41433-019-0364-8
