gms | German Medical Science

Purpose: To compare the visual and refractive outcomes up to 6 months postoperatively following implantation of a ‘Monofocal-Plus’ lens (IOL) implantation after radial keratotomy (RK).

Methods: In a retrospective non-comparative interventional case series, we analyzed the outcomes of ‘Monofocal-Plus’ intraocular lenses (RayOne EMV) implantation performed in the context of cataract surgery following RK. A total of 7 eyes from 4 patients were included in the study. Given the corneal tomography data - Holladay equivalent keratometry readings (EKR), the ASCRS formula was chosen for IOL power calculation. Pre- post-operative visual acuity and manifest refraction, and spherical equivalent were used to assess the surgical procedure’s efficacy, safety and predictability. Distance near visual acuity (40 cm) was also determined.

Results: Phacoemulsification and multifocal IOL implantation were successful in all cases, with neither complications nor adverse events. At 6 months postoperatively, monocular UDVA, DCVA, and UNVA were 0.65±0.30, 0.91±0.23, and 0.78±0.26, respectively (decimal scale). More specifically, 43% of the eyes had DCVA ≥1.0 and 86% showed DCVA≥ 0.8 Regarding pre- vs. post-operative changes, 100% had no lost one line of DCVA, 14% showed no changes, 29% had gained two line of DCVA, and 57% had gained three or more lines. The efficacy and safety indexes were 1.3±0.6 and 1.8±0.5, respectively. As for near vision surgical outcomes, 29% of the eyes had UNVA ≥1.0 and 71% had DCNVA ≥0.8. As for surgical accuracy, 14% of the eyes were within ±0.50 D of the target refraction, whereas 57% were within ±1.00 D.

Conclusion: Cataract surgery in patients who underwent RK is challenging for cataract surgeons due to difficulties encountered while choosing IOL power. The ‘Monofocal-Plus’ IOL implantation based on Holladay EKR report analysis and IOL power calculation using the ASCRS formula showed good cataract treatment results after RK at six months.