Intraocular lens implantation and laser in situ keratomileusis (bioptics) to correct high myopia and hyperopia with astigmatism.

摘要

PURPOSE: To analyze the refractive outcome of moderate to high myopic and hyperopic patients with astigmatism who underwent programmed refractive surgery; first lens phacoemulsification with intraocular lens implantation and 3 months later, laser in situ keratomileusis (LASIK). METHODS: Four men and eight women (22 eyes) with a mean age 47.3 years (range, 38 to 75 yr), and an average spherical equivalent refraction of -11.76 D and +5.22 D and (range, -17.50 to +8.50 D) underwent two refractive procedures. First, phacoemulsification of the lens with a self-sealing incision through clear cornea on the steepest topographic axis and implant of a monofocal intraocular lens in the bag was performed by two experienced surgeons. Second, LASIK was performed with the Nidek EC-5000 excimer laser and the Moria LSK-One microkeratome, by one surgeon. Eyes were divided into two different groups. In the first group, the IOL implanted was calculated to leave the eye slightly myopic, with final correction to be achieved with LASIK. In the second group, the IOL implanted was calculated to achieve emmetropia, correcting any residual refractive error with the laser. RESULTS: After surgery, mean spherical equivalent refraction was +0.26 D (range, -0.375 to +1.50 D). Predictability of refractive outcome: 0 to -1.00 D, 63.63%; +0.25 to +1.00 D, 31.80%; +1.25 to +2.00 D, 4.54%. Mean residual refractive astigmatism was 0.30 D (range, 0 to 1.50 D). Uncorrected visual acuity of 20/20 or better was achieved in 18.3% of eyes; 20/40 or better in 81.8%. No eyes lost two or more Snellen lines of visual acuity and no adverse effects were observed. CONCLUSIONS: Bioptics (phacoemulsification with IOL implantation followed 3 months later by LASIK with the Nidek EC-5000 excimer laser) for correction of moderate to high myopia and hyperopia, with astigmatism, enabled us to treat the total refractive error and adjust final outcomes.