To develop a simple and accurate method for determining appropriate intraocular lens (IOL) power in cataract patients who had prior excimer laser photoablation for myopia or hyperopia, because laser vision corrective surgery interferes with traditional keratometry and corneal topography, rendering IOL power calculations inaccurate.
Private Practice in Century City (Los Angeles), California, and free-standing outpatient surgery centers with institutional review boards.
Based on the empiric experience of the senior author, an IOL power correction factor that was proportional to the prior laser photoablation was determined and applied to the IOL power calculated by the IOLMaster (Zeiss). It was necessary to add to the predicted IOL power in eyes with prior myopic laser ablation, whereas eyes having prior hyperopic laser vision correction required a reduction in the IOL power. The correction factor was applied to 30 eyes that required cataract surgery at some time after laser refractive surgery; 23 eyes had prior treatment for myopia, and the remaining 7 eyes had prior hyperopic laser ablation. A regression formula was generated from the IOL power correction factor that was used in the 30 eyes.
Using the correction factor for 30 eyes, the mean deviation from the desired postcataract refractive outcome was −0.15 diopter (D) ± 0.29 (SD); 28 of 30 eyes were within ±0.5 D of the intended goal; the remaining 2 eyes were both −0.75 D from the desired optical result of cataract surgery. Fourteen of the 30 eyes were emmetropic.
A simple IOL power corrective adjustment regression formula allowed accurate determination of IOL power after laser refractive photoablation surgery. The weakness of the current method is that knowledge of the amount of prior laser vision correction is necessary.