Multifocal intraocular lens implantation after previous corneal refractive laser surgery for myopia

PURPOSE: To describe the refraction and visual acuity outcomes of multifocal intraocular lens (IOL) implantation in patients with previous corneal refractive laser surgery for myopia. SETTING: Academic Medical Center, University of Amsterdam, Amsterdam, and Retina Total Eye Care, Driebergen, the Netherlands. DESIGN: Retrospective cohort study. METHODS: The 3-month results after implantation of a multifocal IOL (Acrysof Restor) in patients who had corneal refractive laser surgery for myopia were analyzed. The primary outcome measures were corrected distance visual acuity, uncorrected distance visual acuity (UDVA), and refraction. The secondary outcome measures were number of laser enhancements, corneal irregularity, pre-laser magnitude of myopia, and posterior capsule opacification (PCO) rate. RESULTS: Seventy-seven eyes of 43 patients were included. Twenty-nine eyes had lens extraction because of cataract, and 48 eyes had a refractive lens exchange. The mean postoperative UDVA was 0.14 logarithm of minimum angle of resolution ± 0.22 (SD). The mean postoperative spherical equivalent was -0.38 ± 0.78 diopter (D). Fifty-seven percent of eyes were within ±0.50 D of emmetropia, and 86% were within ±1.0 D. Sixteen eyes (20.8%) had laser enhancement because of residual refraction. Fourteen eyes (18.2%) had a neodymium:YAG laser capsulotomy because of PCO. Eyes with pre-laser myopia greater than 6.0 D had a less predictable outcome than eyes with pre-laser myopia less than 6.0 D (P = .026). CONCLUSIONS: Multifocal IOL implantation after corneal refractive laser surgery for myopia resulted in good visual acuity and refraction. Results were less predictable with myopia greater than 6.0 D.