Early visual and refractive outcomes of simultaneous-vision IOLs in patients with a history of hyperopic LASIK or FemtoLASIK: a retrospective descriptive cohort study

To report descriptive early visual and refractive outcomes of different simultaneous-vision intraocular lenses (IOLs) implanted during refractive lens exchange (RLE) or cataract surgery in eyes with prior hyperopic LASIK or FemtoLASIK, without comparing individual IOL platforms or functional categories. Acibadem Maslak Hospital and Dunyagoz Etiler Hospital, Istanbul, Turkiye. Retrospective descriptive observational cohort study. Consecutive patients with documented prior hyperopic LASIK/FemtoLASIK who underwent bilateral RLE or cataract surgery with simultaneous-vision IOL implantation were included. IOLs were selected based on preoperative clinical profiles and categorized within the contemporary functional IOL framework as partial depth-of-field (partial-DOFi) enhanced, partial-DOFi extended, and full-DOFi continuous. This taxonomy was used as a descriptive framework only; the study was not powered to compare individual IOL models or functional categories. Primary outcomes included refractive predictability based on postoperative manifest refraction available for the full cohort, cumulative monocular uncorrected distance/intermediate/near visual acuity (UDVA/UIVA/UNVA; logMAR) at postoperative month 3 (POM3), and safety (loss of corrected distance visual acuity [CDVA] ≥ 2 lines). A right-eye-only patient-level sensitivity analysis was performed to assess the potential influence of inter-eye correlation. Sixty-four eyes of 32 patients were analyzed. At POM3, mean UDVA was 0.05 ± 0.05 logMAR; 90.6% achieved ≤ 0.1 logMAR and 96.9% achieved ≤ 0.2 logMAR. Mean CDVA was 0.018 ± 0.037 logMAR; 70.3% achieved ≤ 0.0 logMAR. Refractive predictability was 46.9% within ± 0.50 D and 78.1% within ± 1.00 D; mean absolute prediction error was 0.73 ± 0.58 D. Mean refractive cylinder was − 0.72 ± 0.37 D. Mean UIVA and UNVA were 0.018 ± 0.037 and 0.021 ± 0.038 logMAR; 98.4% achieved ≤ 0.2 logMAR for both. No eye lost ≥ 2 lines of CDVA, and no adverse events were observed through POM3. In the right-eye-only sensitivity analysis, UDVA was ≤ 0.1 logMAR in 87.5% and ≤ 0.2 logMAR in 93.8% of eyes; 46.9% and 71.9% were within ± 0.50 D and ± 1.00 D, respectively. The sensitivity analysis showed the same overall pattern of favorable early visual acuity and modest refractive predictability. In selected eyes with previous hyperopic LASIK/FemtoLASIK, different simultaneous-vision IOLs were associated with favorable descriptive early uncorrected visual acuity across distance, intermediate, and near ranges without loss of ≥ 2 lines of CDVA. However, refractive predictability remained modest and residual astigmatism was not negligible, emphasizing the need for individualized IOL selection, accurate centration, and careful preoperative counseling. Because the cohort was small and included heterogeneous IOL platforms, these findings should not be interpreted as evidence of individual platform-specific or functional category-specific performance. What was known • Prior hyperopic LASIK/FemtoLASIK creates biometric and optical challenges that can reduce refractive predictability after cataract surgery with simultaneous-vision IOLs. • Available evidence for simultaneous-vision IOLs in post-refractive eyes is mainly based on myopic ablation cohorts, with limited data focused on post-hyperopic laser ablation eyes. • Reporting outcomes according to a functional IOL classification is uncommon in this subgroup, making comparisons between studies difficult. What this paper adds • This study reports distance, intermediate, and near visual acuity outcomes and safety data after simultaneous-vision IOL implantation in eyes with prior hyperopic LASIK/FemtoLASIK. • The implanted simultaneous-vision IOLs are described using contemporary functional terminology, while the outcomes are presented descriptively without functional category-specific comparisons. • The study highlights a clinically relevant discrepancy between favorable early uncorrected visual acuity and modest refractive predictability in carefully selected post-hyperopic LASIK/FemtoLASIK eyes.