Opinion|Videos|May 27, 2025
IOL Selection for a Patient Seeking Spectacle Independence After Prior Radial Keratotomy
Author(s)Steven J. Dell, MD
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.
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Video content above is prompted by the following:
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
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