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LENS Surgery After Previous Refractive LENS Surgery After Previous Refractive Corneal Surgery. Personal ResultsCorneal Surgery. Personal Results

145 CASES145 CASES 116 eyes with at least 2 year fup116 eyes with at least 2 year fup

78 eyes after myopia surgery78 eyes after myopia surgery30 after previous hyperopia surgery.30 after previous hyperopia surgery.

72 female 36 male72 female 36 male FRANK JOZEF GOES ANTWERP BELGIUM frank@goes.be No fin.disclosure

GOES EYE CENTREGOES EYE CENTREPROBABLY THE WORLD PROBABLY THE WORLD

RECORD NR of f up cases of lens RECORD NR of f up cases of lens surgery after previous refractive surgery after previous refractive

surgery !!! surgery !!! Started RK 1985-1500 cases

Started Excimer laser surgery 1991:15.000 cases-at that time high myopes till -20D).

Started LTK 1998 later CK 2005-500 cases

We have an Excellent Follow- Up in our private clinic

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PRIMARY REFRACTIVE PRIMARY REFRACTIVE PROCEDUREPROCEDURE %%

0

10

20

30

40

50

60

PRKLASIKRKLTK

0

20

40

60

80

100

120

140

MYOPICExcimer

HYPERExcimer

RK

TIME DELAY OF LENS SURGERY AFTER PRIMARY PROCEDURE MONTHS

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MEAN REFRACTION BEFORE MEAN REFRACTION BEFORE PRIMARY REFRACTIVE PRIMARY REFRACTIVE

PROCEDURE PROCEDURE

-12

-10

-8

-6

-4

-2

0

2

4

MYOPESHYPEROPESRKLTK

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MEAN AGE OF CATARACT SURGERYMEAN AGE OF CATARACT SURGERYIN OUR NORMAL CATARACT POPULATION 74 YIN OUR NORMAL CATARACT POPULATION 74 Y

IN OUR MYOPES AFTER EXCIMER 54 Y IN OUR MYOPES AFTER EXCIMER 54 Y=IMPORTANT DIFFERENCES !!!=IMPORTANT DIFFERENCES !!!

ANY CORRELATION POSSIBLE WITH THE PREVIOUS LASER ANY CORRELATION POSSIBLE WITH THE PREVIOUS LASER TREATMENT ??? TREATMENT ???

0

10

20

30

40

50

60

70

80

NORMAL

MYOPIA> 10 DAFTERPREVIOUSEXCIMER

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SAFETY ALL EYES SAFETY ALL EYES cataract or refractive lens surgery after cataract or refractive lens surgery after

previous corneal refractive surgery previous corneal refractive surgery

0

10

20

30

40

50

60

70

80

90

IDEM GAIN 1 LINEAT LEAST

GAIN 3 LINESAT LEAST

LINES

CLINICAL OUTCOMESCLINICAL OUTCOMESBSCVA- BEFORE AND AFTERBSCVA- BEFORE AND AFTER

0

0,1

0,2

0,3

0,4

0,5

0,6

0,7

0,8

0,9

HYPEROPIA MYOPIA

BEFORE REFRSURGBEFORE CATASURGAFTER CATASURG

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CLINICAL OUTCOMES +/-1 DCLINICAL OUTCOMES +/-1 DIOL POWER CALCULATIONIOL POWER CALCULATION

58%60%62%64%66%68%70%72%74%76%78%80%

HYPEROPIA MYOPIA

+/- 1 D

REFRACTION PREDICTIONREFRACTION PREDICTION HYPEROPIA :Haigis Formula HYPEROPIA :Haigis Formula

0%

10%20%

30%

40%50%

60%

70%80%

90%

100%

+/-0.5 D +/- 1D +/- 2D

Haigis L

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POSTOP REFRACTIVE RESULTS- POSTOP REFRACTIVE RESULTS- REFRACTIONREFRACTION

AFTER MYOPIC CATARACT SURGERY:.

-0.35 D EXTREMES +2 ,75 TO -3,7D

AFTER HYPEROPIC CATARACT SURGERY :-0,4D EXTREMES -2,0 TO+3,0 D

FOLLOW UPFOLLOW UP

More than 5 YEARS 42 EYESMore than 5 YEARS 42 EYES

PIGGY BACK IOL???PIGGY BACK IOL???

CERTAINLY AT THE START 1997CERTAINLY AT THE START 1997IN 7 EYES AFTER M LASER AND IN ONE AFTER H IN 7 EYES AFTER M LASER AND IN ONE AFTER H

LASIK LASIK D POWER :mean +5,6 DD POWER :mean +5,6 D

ND YAG ND YAG MYOPIA 21/77 HYPEROPIA 5/31 EYESMYOPIA 21/77 HYPEROPIA 5/31 EYES

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LENS Surgery After Previous Refractive LENS Surgery After Previous Refractive Corneal SurgeryCorneal Surgery

Is Very rewardingIs Very rewardingand Safeand Safe

Decision making sometimes difficultDecision making sometimes difficult

Iol power calculation improved but still better Iol power calculation improved but still better outcomes for hyperopia compared to myopiaoutcomes for hyperopia compared to myopia

..Myopes after previous excimer laser surgery Myopes after previous excimer laser surgery

develop cataract much earlier !!develop cataract much earlier !!

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