Vance Thompson Vision, Sioux Falls, SD, USA.
Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
Surv Ophthalmol. 2024 Jan-Feb;69(1):140-159. doi: 10.1016/j.survophthal.2023.08.002. Epub 2023 Aug 26.
A growing number of patients with prior refractive surgery are now presenting for cataract surgery. Surgeons face a number of unique challenges in this patient population that tends to be highly motivated to retain or regain functional uncorrected acuity postoperatively. Primary challenges include recognition of the specific type of prior surgery, use of appropriate intraocular lens (IOL) power calculation formulas, matching IOL style with spherical aberration profile, the recognition of corneal imaging patterns that are and are not compatible with toric and/or presbyopia-correcting lens implantation, and surgical technique modifications, which are particularly relevant in eyes with prior radial keratotomy or phakic IOL implantation. Despite advancements in IOL power formulae, corneal imaging, and IOL options that have improved our ability to achieve targeted postoperative refractive outcomes, accuracy and predictability remain inferior to eyes that undergo cataract surgery without a history of corneal refractive surgery. Thus, preoperative evaluation of patients who will and will not be candidates for postoperative refractive surgical enhancements is also paramount. We provide an overview of the specific challenges in this population and offer evidence-based strategies and considerations for optimizing surgical outcomes.
越来越多曾接受过屈光手术的患者现在需要进行白内障手术。对于这类患者，外科医生需要面对许多独特的挑战，因为他们通常非常希望在术后保持或恢复未经矫正的功能性视力。主要挑战包括识别特定的既往手术类型、使用适当的眼内晶状体（IOL）计算公式、根据球差特性选择合适的 IOL 类型、识别与散光或多焦点人工晶状体（IOL）植入术相匹配或不匹配的角膜成像模式，以及手术技术的调整，这些在曾行放射状角膜切开术或有晶状体眼 IOL 植入的患者中尤为重要。尽管 IOL 计算公式、角膜成像和 IOL 选择方面取得了进步，提高了我们实现目标术后屈光效果的能力，但准确性和可预测性仍不如未行角膜屈光手术的患者。因此，对于那些有术后屈光手术增强适应证和禁忌证的患者，术前评估也至关重要。我们概述了该人群中存在的具体挑战，并提供了基于证据的策略和注意事项，以优化手术结果。
