title: Resolving refractive error after cataract surgery: IOL exchange, piggyback lens, or LASIK.
abstract: OBJECTIVE
  To evaluate the efficacy, predictability, and safety of three different procedures (intraocular lens [IOL] exchange, piggyback lens implantation, and LASIK) to correct residual refractive error following cataract surgery.
  
  
  METHODS
  A retrospective multicenter study comprised 65 eyes of 54 patients that underwent phacoemulsification, resulting in a unacceptable final refractive error. Eyes were divided into three groups: eyes that had an IOL lens exchange (17 eyes), eyes that had a piggyback lens implanted (20 eyes), and eyes that had LASIK (28 eyes).
  
  
  RESULTS
  No differences between the IOL exchange and piggyback lens groups in the spherical equivalent, sphere, or cylinder were found (P = .072, .436, and .081, respectively). The LASIK group showed a statistically significant reduction in spherical equivalent and refractive cylinder when compared with the IOL exchange group (P < .001 and P = .001, respectively). The LASIK group showed statistically significant reduced refractive cylinder in comparison with the piggyback lens group (P = .002). The median efficacy index was 0.58 (range: 0.28 to 0.93), 0.75 (range: 0.65 to 0.92), and 0.91 (range: 0.85 to 1.14) in the IOL exchange, piggyback lens, and LASIK groups, respectively. Statistically significant differences were found between the IOL exchange and LASIK groups (P = .004) and the piggyback lens and LASIK groups (P = .003). No statistically significant differences were detected in the safety index among groups (P = .094). The predictability (±1 diopters of final spherical equivalent) was 62.5% of eyes in the IOL exchange group, 85% of eyes in the piggyback lens group, and 100% of eyes in the LASIK group.
  
  
  CONCLUSIONS
  The three procedures were effective. The LASIK group showed the best outcomes in efficacy and predictability.
authors.forename: Roberto
authors.initials: R
authors.lastname: Fernández-Buenaga
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Alió
authors.forename: Andrés L
authors.initials: AL
authors.lastname: Pérez Ardoy
authors.forename: Adrián Larrosa
authors.initials: AL
authors.lastname: Quesada
authors.forename: Laura
authors.initials: L
authors.lastname: Pinilla-Cortés
authors.forename: Laura
authors.initials: L
authors.lastname: Pinilla Cortés
authors.forename: Rafael I
authors.initials: RI
authors.lastname: Barraquer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D020731:Keratomileusis, Laser In Situ; D054018:Lasers, Excimer / Q000627:therapeutic use*; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D018918:Phacoemulsification; D011183:Postoperative Complications; D012029:Refraction, Ocular / Q000502:physiology; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology