Case 2 was that of a patient who was referred with a dense central corneal scar after a previous RK procedure and recently having undergone cataract surgery. The on-cornea scar in many of these cases can be peeled off in the right plane resulting in improved vision (without need for any transplant) and he was already pleased with his vision so much that he defered the planned laser corneal advanced surface ablation surgery (ASA) to emmetropia.
Another patient was referred by his eye surgeon following implantation of an accommodative IOL in an eye treated previously with RK. Before a knee-jerk reaction of exchanging the implant, I always look at refractive errors and offer simulation to look for symptomatic improvements (BVP).
Once the ocular surface is corrected, the refractive errors can be addressed using surface laser ASA (the new-carpet-over-broken-tiles approach) and achieve visual satisfaction.
Most patients with RKâand for that matter any previous corneal surgeries who have bad endpoints after multifocal and premium IOL implantsâusually have some residual refractive error, most often astigmatism.
I encourage surgeons to make sure that the refractive endpoint is always neutral before blaming the IOL implant. These cases can be corrected easily with corneal refractive surgery to excellent endpoints, thus maximizing the impact of the premium lens implant to achieve optimal vision.