Penn State College of Medicine, Hershey, Pennsylvania.
Byers Eye Institute, Stanford University, Palo Alto, California.
Ophthalmology. 2021 May;128(5):781-792. doi: 10.1016/j.ophtha.2020.10.031. Epub 2021 Jan 24.
To review the literature to evaluate the outcomes of intraocular lens (IOL) power calculation in eyes with a history of myopic LASIK or photorefractive keratectomy (PRK).
Literature searches were conducted in the PubMed database in January 2020. Separate searches relevant to cataract surgery outcomes and corneal refractive surgery returned 1169 and 162 relevant citations, respectively, and the full text of 24 was reviewed. Eleven studies met the inclusion criteria for this assessment; all were assigned a level III rating of evidence by the panel methodologist.
When automated keratometry was used with a theoretical formula designed for eyes without previous laser vision correction, the mean prediction error (MPE) was universally positive (hyperopic), the mean absolute errors (MAEs) and median absolute errors (MedAEs) were relatively high (0.72-1.9 diopters [D] and 0.65-1.73 D, respectively), and a low (8%-40%) proportion of eyes were within 0.5 D of target spherical equivalent (SE). Formulas developed specifically for this population requiring both prerefractive surgery keratometry and manifest refraction (i.e., clinical history, corneal bypass, and Feiz-Mannis) produced a proportion of eyes within 0.5 D of target SE between 26% and 44%. Formulas requiring only preoperative keratometry or no history at all had lower MAEs (0.42-0.94 D) and MedAEs (0.30-0.81 D) and higher (30%-68%) proportions within 0.5 D of target SE. Strategies that averaged several methods yielded the lowest reported MedAEs (0.31-0.35 D) and highest (66%-68%) proportions within 0.5 D of target SE. Even after using the best-known methods, refractive outcomes were less accurate in eyes that had previous excimer laser surgery for myopia compared with those that did not have it.
Calculation methods requiring both prerefractive surgery keratometry and manifest refraction are no longer considered the gold standard. Refractive outcomes of cataract surgery in eyes that had previous excimer laser surgery are less accurate than in eyes that did not. Patients should be advised of this refractive limitation when considering cataract surgery in the setting of previous corneal refractive surgery. Conclusions are limited by the small sample sizes and retrospective nature of nearly all existing literature in this domain.
回顾文献评估既往近视 LASIK 或准分子激光角膜切削术（PRK）的眼内人工晶状体（IOL）屈光力计算的结果。
2020 年 1 月在 PubMed 数据库中进行文献检索。单独搜索白内障手术结果和角膜屈光手术的结果分别返回了 1169 条和 162 条相关引文，并对 24 篇全文进行了回顾。11 项研究符合本评估的纳入标准；所有研究均被小组方法学家评为 III 级证据。
当使用针对未经先前激光视力矫正的眼设计的理论公式进行自动角膜曲率测量时，平均预测误差（MPE）普遍为正（远视），平均绝对误差（MAE）和中位数绝对误差（MedAE）相对较高（分别为 0.72-1.9 屈光度 [D] 和 0.65-1.73 D），且仅有 8%-40%的眼在目标等效球镜（SE）的 0.5 D 以内。专门针对需要术前屈光手术角膜曲率和眼前节检查（即临床病史、角膜旁路和 Feiz-Mannis）的人群开发的公式，在目标 SE 的 0.5 D 以内的眼的比例在 26%-44%之间。仅需要术前角膜曲率或根本不需要病史的公式具有较低的 MAE（0.42-0.94 D）和 MedAE（0.30-0.81 D），并且在目标 SE 的 0.5 D 以内的比例较高（30%-68%）。使用几种方法的平均值的策略得出的报告的 MedAE 最低（0.31-0.35 D），在目标 SE 的 0.5 D 以内的比例最高（66%-68%）。即使使用最知名的方法，既往接受过准分子激光治疗近视的眼的屈光结果也不如从未接受过此类治疗的眼准确。在考虑既往角膜屈光手术后的白内障手术时，应告知患者这种屈光限制。由于该领域几乎所有现有文献的样本量较小且均为回顾性，因此结论受到限制。
