Multifocal Intraocular Lens Implantation After Laser In Situ Keratomileusis

To report the refractive and visual outcomes of multifocal intraocular lens (IOL) implantation after previous LASER in situ keratomileusis (LASIK). 

Refractive Surgery Unit of the Ophthalmology Department of Centro Hospitalar Universitário do Porto, Oporto, Portugal

Retrospective case series that included patients who had implantation of multifocal IOL after previous LASIK. Information collected included near and distance uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and the spherical equivalent (SE) before and after the surgery. 

A total of 4 eyes of 2 patients were included. In all cases, an AT LISA bifocal IOL was implanted in the capsular bag. No intra and post-operative complications developed. The mean preoperative spherical equivalent (SE) was -1.97 ± 1.73 D (range -0.25 to -4.25 D). Three months after surgery, the mean SE was -0.59 ± 0.73 D (range 0.00 to -1.50 D), with two eyes achieving emmetropia. No patient lost lines of BCVA after surgery. One eye underwent photorefractive keratectomy posteriorly to correct the residual refractive error. At last follow-up, both patients were satisfied and spectacle independent for near and distance vision with only 1 patient complaining of non-disabling nocturnal glare and halos.  

IOL calculation after previous LASIK surgery poses a particular challenge. Regarding multifocal IOL, added to this difficulty is the fear of worsening the quality of vision due to the decrease in contrast sensitivity and the exacerbation of night vision symptoms. Careful selection of patients, discussion of realistic expectations and alerting to the possible need for other procedures and/or the use of glasses is essential for obtaining the best results. In our sample, multifocal IOL implantation after previous LASIK provided good results.