Kuo Irene C, O'Brien Terrence P, Broman Aimee T, Ghajarnia Mehdi, Jabbur Nada S
Wilmer Eye Institute, Baltimore, Maryland 21236, USA.
J Cataract Refract Surg. 2005 Nov;31(11):2104-10. doi: 10.1016/j.jcrs.2005.08.023.
To review the cases of patients who had excimer laser refractive surgery to correct unintentional or undesired ametropia after cataract extraction with intraocular lens (IOL) implantation.
Wilmer Laser Vision Correction Center, Wilmer Eye Institute, Baltimore, Maryland, USA.
In this retrospective noncomparative review of consecutive cases, the Wilmer Laser Vision Correction Center's database was searched for patients who had laser in situ keratomileusis or photorefractive keratectomy to correct ametropia after cataract extraction with IOL implantation.
Using the Visx Star excimer laser system (Visx, Inc.), 11 procedures were performed in 11 eyes of 10 patients a mean of 47 months (range 2 to 216 months) after cataract extraction with IOL implantation. Except for 1 patient with a silicone plate lens, all patients received 3-piece poly(methyl methacrylate) lenses. The mean age at time of excimer treatment was 75 years (range 70 to 81 years). Before laser surgery, the mean spherical equivalent of patient eyes was -3.76 diopters (D) +/- 2.50 (SD) (range -6.50 to +0.75 D), spherical refraction ranged from -9.00 D to plano, and the highest cylindrical refraction was +5.50 D. At last follow-up (mean 12.2 months; range 1 to 38 months), the mean manifest spherical equivalent was -0.88 +/- 1.43 D (range -2.75 to +2.13 D). Changes in mean manifest spherical equivalent were highly significant (P = .03, Wilcoxon signed rank test for paired values). There was no difference between targeted and achieved postoperative refraction (P = .34, Wilcoxon test). Increasing age was correlated with a hyperopic shift (r = 0.525, P = .05). All patients were satisfied with their final uncorrected visual acuity (UCVA), which improved in every case. Except for 1 patient in whom an epiretinal membrane developed, best spectacle-corrected visual acuity remained unchanged or improved.
In this series of patients, who were a few decades older than the typical excimer laser candidate, laser refractive surgery was a safe, effective, and predictable method to correct ametropia after cataract extraction with IOL implantation. It may be a viable, noninvasive alternative to intraocular surgery, which has potential complications. Although satisfactory for all patients, final UCVA was not as high as that reported in laser refractive surgery patients in general, and this result may be because of prior cataract extraction with IOL implantation or increased age.
回顾接受准分子激光屈光手术以矫正白内障摘除联合人工晶状体（IOL）植入术后意外或非预期屈光不正患者的病例。
美国马里兰州巴尔的摩威尔默眼科研究所威尔默激光视力矫正中心。
在这项对连续病例的回顾性非对照研究中，检索威尔默激光视力矫正中心数据库，查找接受准分子原位角膜磨镶术或光性屈光性角膜切削术以矫正白内障摘除联合IOL植入术后屈光不正的患者。
使用威视准分子激光系统（威视公司），对10例患者的11只眼进行了11次手术，平均在白内障摘除联合IOL植入术后47个月（范围2至216个月）进行。除1例患者植入硅胶板状晶状体外，所有患者均植入三件式聚甲基丙烯酸甲酯晶状体。准分子治疗时的平均年龄为75岁（范围70至81岁）。激光手术前，患者术眼的平均等效球镜度为-3.76屈光度（D）±2.50（标准差）（范围-6.50至+0.75 D），球镜度范围为-9.00 D至平光，最高柱镜度为+5.50 D。在最后一次随访时（平均12.2个月；范围1至38个月），平均显验光等效球镜度为-0.88±1.43 D（范围-2.75至+2.13 D）。平均显验光等效球镜度的变化具有高度显著性（P = 0.03，配对值的Wilcoxon符号秩检验）。目标术后屈光度与实际术后屈光度之间无差异（P = 0.34，Wilcoxon检验）。年龄增加与远视性偏移相关（r = 0.525，P = 0.05）。所有患者对其最终裸眼视力（UCVA）均满意，且每种情况下视力均有改善。除1例患者发生视网膜前膜外，最佳矫正视力保持不变或提高。
在这组比典型准分子激光手术候选者大几十岁的患者中，激光屈光手术是矫正白内障摘除联合IOL植入术后屈光不正的一种安全、有效且可预测的方法。它可能是一种可行的、非侵入性的替代眼内手术的方法，眼内手术有潜在并发症。尽管对所有患者都令人满意，但最终UCVA不如一般激光屈光手术患者报告的高，这一结果可能是由于先前的白内障摘除联合IOL植入或年龄增加所致。
