Secondary procedures after presbyopic lens exchange.
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.
Leccisotti
Antonio
A
Ophthalmic Surgery Unit, Casa di Cura Rugani, Piazza 5o Bersaglieri 2, 53100 Siena, Italy. leccisotti@libero.it
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