Roszkowska Anna Maria, Urso Mario, Signorino Giuseppe Alberto, Spadea Leopoldo, Aragona Pasquale
Department of Surgery, Ophthalmology Clinic, University Hospital of Messina, Messina 98124, Italy.
Department of Ophthalmology, Andrzej Frycz Modrzewski Krakow University, Kraków 33332, Poland.
Int J Ophthalmol. 2018 Apr 18;11(4):612-615. doi: 10.18240/ijo.2018.04.12. eCollection 2018.
To evaluate the efficacy and safety of the excimer laser correction of the residual refractive errors after cataract extraction with intraocular lens (IOL) implantation in uncommon cases.
Totally 24 patients with high residual refractive error after cataract surgery with IOL implantation were examined. Twenty-two patients had a history of phacoemulsification and IOL implantation, and two had extra-capsular cataract extraction with IOL implantation. Detailed examination of preoperative medical records was done to explain the origin of the post-cataract refractive errors. All patients underwent photorefractire keratectomy (PRK) enhancement. The mean outcome measures were refraction, uncorretted visual acuity (UCVA), best corrected visual acuity (BCVA) and corneal transparency and follow up ranged from 1 to 8y.
The principal causes of residual ametropia was inexact IOL calculation in abnormal eyes with high myopia and congenital lens abnormalities, followed by corneal astigmatism both suture induced and preexisting. After cataract surgery and before the laser enhancement the mean spherical equivalent (SE) was -0.56±3 D ranging from -4.62 to +2.25 D in high myopic patients, instead it was -1±1.73 D ranging from -3.25 to +3.75 D in the astigmatic eyes, with a mean cylinder of -3.75±0 ranging from -3 to +5.50 D. After laser refractive surgery the mean SE was 0.1±0.73, ranging from -0.50 to +1.50 in the myopic group, and it was -0.50±0.57 ranging from -1.25 to +0.50 in astigmatic patients, with a mean cylinder of -0.25±0.75. In myopic patients the mean UCVA and BCVA were 0.038±0.072 logMAR and 0.018±0.04 respectively, both ranging from 0.10 to 0.0. In astigmatic patients, the mean UCVA and BCVA were 0.213±0.132 and 0.00±0.0 respectively, UCVA ranging from 0.50 to 0.22 and BCVA was 0.00. All patients presented normal corneal transparency. No ocular hypertension was detected and no corneal haze was observed. All registered values remained stable also at the end line evaluation.
The excimer laser treatment of residual refractive errors after cataract surgery with IOL implantation in abnormal eyes resulted in satisfactory and stable visual outcome with good safety and efficacy.
评估准分子激光矫正白内障摘除联合人工晶状体（IOL）植入术后罕见病例残余屈光不正的疗效和安全性。
对24例白内障手术联合IOL植入术后存在高度残余屈光不正的患者进行检查。22例患者有超声乳化白内障吸除联合IOL植入史，2例有白内障囊外摘除联合IOL植入史。详细检查术前病历以解释白内障术后屈光不正的原因。所有患者均接受了准分子原位角膜磨镶术（PRK）增效治疗。主要观察指标为验光、未矫正视力（UCVA）、最佳矫正视力（BCVA）和角膜透明度，随访时间为1至8年。
残余屈光不正的主要原因是高度近视和先天性晶状体异常的异常眼中IOL计算不准确，其次是缝线诱导和术前存在的角膜散光。白内障手术后及激光增效治疗前，高度近视患者的平均球镜等效度（SE）为-0.56±3D，范围为-4.62至+2.25D；散光眼中平均SE为-1±1.73D，范围为-3.25至+3.75D，平均柱镜为-3.75±0，范围为-3至+5.50D。激光屈光手术后近视组平均SE为0.1±0.73，范围为-0.50至+1.50；散光患者平均SE为-0.50±0.57，范围为-1.25至+0.50，平均柱镜为-0.25±0.75。近视患者平均UCVA和BCVA分别为0.038±0.072 logMAR和0.018±0.04，范围均为0.10至0.0。散光患者平均UCVA和BCVA分别为0.213±0.132和0.00±0.0，UCVA范围为0.50至0.22，BCVA为0.00。所有患者角膜透明度均正常。未检测到眼压升高，未观察到角膜混浊。所有记录值在最终评估时也保持稳定。
准分子激光治疗异常眼中白内障手术联合IOL植入术后的残余屈光不正，可获得满意且稳定的视觉效果，安全性和疗效良好。
