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IOL Selection for a Patient Seeking Spectacle Independence After Prior Radial Keratotomy

A panelist discusses how he successfully treated a complex case of a 72-year-old patient with previous radial keratotomy by using an innovative combination of an Apthera lens in the bag and a light adjustable lens in the sulcus as a primary piggyback.

Video content above is prompted by the following:

Complex Case Study: PostRadial Keratotomy (RK) Cataract Patient

Key Discussion Topics

  • Complex post-RK case presentation
    • A 72-year-old man with 16-incision RK performed 22 years prior
    • Extreme refractive error (+8.00 with 5 D of astigmatism)
    • Significant irregular astigmatism with central corneal power ranging from 28 to 36 D
  • Surgical challenges
    • Visual acuity (20/50) worse than expected for cataract density (appearing 20/25)
    • Patient improved with pinhole, indicating irregular astigmatism
    • Required intraocular lens (IOL) power (35-36 D) exceeded available Apthera lens maximum (30 D)
  • Novel surgical approach
    • Placement of Apthera IOL in the capsular bag
    • Use of scleral tunnel incision due to 16-incision RK history
    • Off-label placement of light adjustable lens in the sulcus as a primary piggyback IOL

Notable Outcomes

  • Preadjustment refraction was +1.75 –4.00, a significant improvement
  • After light adjustable lens adjustments, patient achieved 20/25 vision with minimal residual refractive error
  • Similar piggyback approach with monofocal IOL plus light adjustable lens used successfully in the fellow eye

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