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

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Complex Case Study: Post–Radial 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