Intraocular lens power calculation after corneal refractive surgery.
OBJECTIVE
Keratorefractive procedures designed to decrease refractive errors have gained enormous popularity among ophthalmologists and patients. As the post-refractive surgery patient population ages, visually significant cataracts will develop. With advances in techniques for cataract extraction and intraocular lens implantation, cataract surgery has evolved into a refractive surgical procedure as well as an operation to improve best corrected visual acuity. This raises expectations in terms of desired postoperative refractive status and uncorrected visual acuity. Although performing modern cataract surgery in post-refractive surgery eyes is technically no more complicated than operating on virgin eyes, the calculation of intraocular lens power for a desired refractive target can be challenging and complicated. This has become increasingly apparent as case reports of "refractive surprises" after cataract surgery appear in the literature more frequently.


RESULTS
This paper reviews the current clinical experience with intraocular lens power determination after cataract surgery in post-keratorefractive patients, provides an overview of possible sources of error in intraocular lens power calculation in these patients, and analyzes methods to minimize intraocular lens power errors.


CONCLUSIONS
The clinical and routine methods of intraocular lens power determination after keratorefractive surgery need to be modified to improve accuracy. Our knowledge of this subject is still evolving. Given the enormous impact of this problem on clinical practice, awareness of the shortcomings and suggested methods to improve accuracy can be valuable to clinicians.
Feiz
Vahid
V
Department of Ophthalmology, University of Arkansas for Medical Sciences, Jones Eye Institute, Little Rock, Arkansas 72211, USA. Vfeiz@uams.edu
Mannis
Mark J
MJ
D002386:Cataract / Q000209:etiology; D002387:Cataract Extraction; D003315:Cornea / Q000601:surgery*; D006801:Humans; D007910:Lenses, Intraocular; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects; D055095:Optics and Photonics; D054140:Refractive Surgical Procedures