Multifocal intraocular lens implantation after previous hyperopic corneal refractive laser surgery

Purpose: To describe the outcomes in terms of the refraction and visual acuity of multifocal intraocular lens (IOL) implantation in patients with previous hyperopic corneal refractive laser surgery. Setting: Academic Medical Center, University of Amsterdam, Amsterdam, and Retina Total Eye Care, Driebergen, the Netherlands. Design: Retrospective case series. Methods: Results were analyzed 3 months after implantation of a multifocal IOL (Acrysof Restor SN6AD1) in patients after previous corneal refractive laser surgery for hyperopia. The primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and refraction. The secondary outcome measures were the number of laser enhancements and posterior capsule opacification (PCO) rates. Results: Forty eyes of 40 patients were included. Sixteen eyes (40.0%) had lens extraction because of cataract, and 24 eyes (60.0%) had refractive lens exchange. The mean postoperative UDVA was 0.16 logarithm of the minimum angle of resolution (logMAR) +/- 0.18 (SD), and the mean postoperative CDVA was 0.01 +/- 0.08 logMAR. The mean postoperative spherical equivalent was 0.04 +/- 0.92 diopter (D). Twenty-five eyes (62.5%) were within +/- 0.50 D of emmetropia, and 35 eyes (87.5%) were within +/- 1.0 D of emmetropia. Nine eyes (22.5%) had a laser enhancement because of a residual refraction error. Eleven eyes (27.5%) had a neodymium:YAG laser capsulotomy because of PCO. Conclusions: In general, multifocal IOL implantation after corneal refractive laser surgery for hyperopia resulted in good visual acuity and refraction. The magnitude of previous hyperopia did not influence the refractive predictability.