Purpose: To review the specific challenges and pitfalls that vitreoretinal surgeons may face when operating on eyes with presbyopia-correcting intraocular lenses or previous corneal refractive surgery. In addition, this review aims to familiarize vitreoretinal surgeons with specifications of currently available Food and Drug Administration–approved presbyopia-correcting intraocular lenses.
Methods: Review of current literature performed with PubMed for search terms “presbyopia,” “correction,” “IOL,” “vitreoretinal,” “challenges,” and “surgical” both singly and in combination as well as closely related terms.
Results and Conclusion: Specific intraoperative issues with presbyopia-correcting intraocular lenses that may be encountered include peripheral visualization, condensation, lens material issues particularly with silicone oil, decentration, Z-syndrome, and foveal image displacement. Every patient undergoing retinal surgery should also be asked about previous laser-assisted in situ keratomileusis/photorefractive keratectomy because those eyes require special attention to surface hydration and care to avoid epithelial removal if possible. Intracorneal ring segments and corneal inlays can cause effects similar to those of a small pupil. However, these can be managed with thorough preoperative evaluation and various intraoperative maneuvers. In addition, retinal physicians should be aware that macular disorders, such as age-related macular degeneration, may be exacerbated by potential loss of contrast sensitivity.
Presbyopia-correcting intraocular lenses and previous corneal refractive surgery pose unique but manageable challenges for vitreoretinal surgery. These include decentration, condensation, lens material issues, peripheral visualization, Z-syndrome, corneal epithelium removal issues, and foveal image displacement. In addition, retinal physicians should be aware that macular disorders, such as age-related macular degeneration, may be exacerbated by potential loss of contrast sensitivity.
*The Retina Institute/Retina Consultants, St Louis, Missouri; and
†Minnesota Eye Consultants, Minneapolis, Minnesota.
Reprint requests: Gaurav K. Shah, MD, Retina Consultants, 1600 South Brentwood Avenue, Suite 800, St Louis, MO 63144; e-mail: email@example.com
D. R. Hardten consults for Abbott Medical Optics, Inc. The other authors have no financial/conflicting interests to disclose.
B. U. Ahmad is a fellow at The Retina Institute (TRI) in St Louis, MO. G. K. Shah is a fellowship codirector and an attending physician at TRI. D. R. Hardten is the director of Refractive Surgery at Minnesota Eye Consultants in Minneapolis.