title: Secondary procedures after presbyopic lens exchange.
abstract: OBJECTIVE
  To assess the indications, incidence, and outcome of secondary procedures after presbyopic lens exchange (PRELEX).
  
  
  METHODS
  Private practice, Siena, Italy.
  
  
  METHODS
  This prospective nonrandomized single-surgeon study comprised 52 patients having PRELEX by phacoemulsification and multifocal intraocular lens (IOL) implantation. The preoperative mean spherical equivalent (SE) was +2.50 diopters (D) +/- 1.38 (SD) (range 0 to +6.0 D).
  
  
  RESULTS
  Monocular PRELEX was performed in 8 patients who canceled the fellow-eye surgery because of halos; in this group, the residual refractive error was corrected by photorefractive keratectomy (PRK) in 4 eyes, but this did not alleviate halos and IOL exchange was ultimately needed in 7 eyes. Binocular PRELEX was completed in 44 patients; in this group, 14 eyes (8 patients) had PRK for a residual error. The postoperative mean absolute SE in the 18 PRK-treated eyes was 0.33 D (95% confidence interval [CI] of improvement, 0.57-1.32) and the mean uncorrected visual acuity, 0.8 (95% CI of improvement, 0.32-0.45). The final SE was within +/-0.5 D in 15 eyes (83.0%) and within +/-1.0 D in 18 eyes. Halos after PRK were unchanged in 6 patients, slightly improved in 4, and improved in 2. Photorefractive keratectomy or IOL exchange was needed in eyes with a preoperative SE between plano and +1.75 D (15/40 eyes, 38%) and not needed in eyes with a preoperative SE greater than +1.75 D (0%) (95% CI of difference, 23%-53%).
  
  
  CONCLUSIONS
  Presbyopic lens exchange in eyes with emmetropia and low hyperopia was associated with a significantly higher percentage of secondary procedures. Photorefractive keratectomy enhancement can improve distance vision but has a limited effect on halos.
authors.affiliation: Ophthalmic Surgery Unit, Casa di Cura Rugani, Piazza 5o Bersaglieri 2, 53100 Siena, Italy. leccisotti@libero.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Leccisotti
mesh_terms: D000065:Accommodation, Ocular / Q000502:physiology; D020878:Device Removal; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000209:etiology / Q000601:surgery*; D054018:Lasers, Excimer; D019654:Lens Implantation, Intraocular / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D018903:Photorefractive Keratectomy; D011183:Postoperative Complications; D011305:Presbyopia / Q000601:surgery*; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D012086:Reoperation; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology