title: Prevention of hyperopic surprise after LASIK in patients with refractive multifocal intraocular lenses.
abstract: OBJECTIVE
  Three cases of patients who developed a similar hyperopic defect in refraction following laser in situ keratomileusis (LASIK) after multifocal intraocular lens (IOL) implantation are described.
  
  
  METHODS
  Ophthalmologic evaluation including refractive status, corrected and uncorrected visual acuity (both at far and near), and corneal topography in patients presenting similar hyperopic refractive surprise in one eye as a result of LASIK refinement of residual ametropia after refractive multifocal IOL implantation.
  
  
  RESULTS
  Laser in situ keratomileusis enhancement for residual ametropia of -1.00 to -1.50 D in patients with a prior implantation of refractive multifocal IOL resulted in a refractive surprise of +2.25 to +2.50 D. After excluding other possible sources of error, an explanation for such a refractive surprise is suggested, and a simple method for avoiding this error is presented.
  
  
  CONCLUSIONS
  Proper knowledge of the defocus curve and the use of a systematic method for determining subjective refraction in patients implanted with refractive multifocal IOLs will reduce the possibility of refractive surprise after LASIK enhancement in a bioptics procedure.
authors.affiliation: Refractive Surgery Department, Marqués de Sotelo Ophthalmological Center and Hospital NISA Valencia al Mar, Valencia, Spain. cesar.albarran@gmail.com
authors.forename: César
authors.initials: C
authors.lastname: Albarrán-Diego
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Muñoz
authors.forename: Teresa
authors.initials: T
authors.lastname: Ferrer-Blasco
authors.forename: Santiago
authors.initials: S
authors.lastname: García-Lázaro
mesh_terms: D002387:Cataract Extraction; D019781:Corneal Topography; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000209:etiology / Q000517:prevention & control*; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000601:surgery*; D012029:Refraction, Ocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology