Success possible with apodized diffractive lens in prior-LASIK patients

Use of an apodized diffractive IOL (ReSTOR, Alcon Laboratories) in patients needing cataract surgery after prior refractive surgery is considered to be contraindicated, but excellent outcomes can be achieved if optical results are near emmetropia, according to Samuel Masket, MD, of Advanced Vision Care, Los Angeles.

"We can be very successful with these lenses in prior LASIK-correction patients, but the success depends, obviously, on control of surgically induced astigmatism, using accurate formulae, careful patient selection, and enhancement as necessary," he said.

Dr. Masket implanted the multifocal lens in 26 eyes post-LASIK. Nine patients received the implant in both eyes. Thirteen of the patients had had prior hyperopic laser correction, and 13 had had prior myopic correction.

"The question I sought to answer: Is it a good idea to put the . . . lens in patients with prior LASIK, knowing that these patients have very high expectations from the outcome of surgery?" he said.

"On one side, when we look at the FDA trials, one of the strong indications is, in fact, patients who no longer desire to wear glasses," he said. "Well, that matches post-LASIK patients. But on the exclusion side, patients who had previous refractive surgery were excluded from the FDA trials, and that would, therefore, be a contraindication."

Astigmatism must be managed, and "post-refractive surgery corneal curvature becomes a big factor in these patients as well," Dr. Masket said.

On the other hand, he added, an "advantage that you have in the post-LASIK patient is that many of them could have their flaps lifted if there was adequate tissue for you to make an enhancement for them."

In terms of visual outcomes in Dr. Masket's study, 24 out of 26 eyes had a visual acuity of 20/30 or better, and uncorrected near visual acuity was J2 or better in 24 out of 26.

"I had to do additional limbal relaxing or peripheral corneal relaxing incisions in two," he said. "I lifted a flap in one. One patient had a piggyback for 1 D and for negative dysphotopsia."

All of the binocular implantation patients were spectacle-free, Dr. Masket said, adding that only two of eight patients in whom only one lens had been implanted were spectacle-free.