Eyeworld

34 | EYEWORLD | MAY 2019 R EFRACTIVE Addressing the complaints of pseudopha- kic patients who are unhappy with their mul- tifocal implant results can be daunting for the surgeon after uncomplicated cataract surgery. Once potential ocular surface and capsule clar- ity issues are addressed as contributing factors, the surgeon may consider the option of per- forming an intraocular lens exchange. This can be accomplished successfully in most situations, but it exposes the patient to the inherent risks associated with a secondary intraocular pro- cedure. Patients receiving monofocal cataract implants wanting uncorrected reading vision can be equally problematic. In the three cases presented here, multifo- cal implant patients with significant quality of continued from page 32 Case 2 71-year-old male with past history of bilateral cataract surgery with Tecnis +2.75 multifocal IOL (model ZKB00) (6/12); S/P YAG capsulotomy; patient complains of worsening quality of vision characterized by glare from bright light sources affecting both distance and near acuity and problematic vision while driving Preoperative findings (6/20/17) UCVA OD: 20/20-1 J1+ glare testing 20/50 UCVA OS: 20/20-1 J1+ glare testing 20/50 MR OD: –0.75-0.25 x 055 20/20-1 MR OS: –0.50-0.25 x 103 20/20-1 Ocular dominance: OD HD OS: OSI 1.6 OSI mean 2.05 Central corneal thickness: 504 µm Surgical planning (9/22/17) Pocket KAMRA implantation – OS Femtosecond laser pocket depth: 250 µm Postoperative findings 8/10/18 UCVA OS: 20/30 J1+ Patient comments: Less visual fatigue; glare issue improved; happy with near vision Case 3 64-year-old female 6 months post-cataract sur- gery with monofocal implants and nondominant OS targeted for –0.75 D outcome; patient was unhappy with visual quality and range of near acuity and wished to see better in the distance and be independent of reading glasses Preoperative findings (9/16/18) UCVA OD: 20/20 J7 UCVA OS: 20/40 J3 (difficult) MR OD: +0.25-0.50 x 180 20/20 MR OS: –0.75-0.50 x 65 20/20 Ocular dominance: OD HD OS: OSI 0.70 OSI mean 1.25 Central corneal thickness: 587 µm Surgical planning (11/27/18) Pocket KAMRA implantation Femtosecond laser pocket depth: 280 µm Postoperative findings 12/20/18 UCVA OS: 20/25+3 J1+ Patient comments: Patient delighted with improved acuity at both distance and near ranges KAMRA inlay at 280 micron corneal depth in patient with a monofocal IOL targeted for –0.75 Source: Martin Fox, MD Experience EyeWorld's print publications online Digital.EyeWorld.org ASCRS

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