Question: In 1994 I had RK (extensive - 16 cuts in right eye). I recently had cataract surgery on right eye but vision correction, even using the ORA System, was not totally successful. My cataract surgeon is now suggesting "piggyback" IOL to further correct vision. Should I consider this and what are the possible complications?
Answer: Cataract surgery and lens implants after RK is more complex than routine cataract surgery where there has been no previous corneal surgery. The complexity of the measurements and calculations diminishes the precision of the lens implant calculations and should there be a need for an adjustment and refinement of the final prescription, the previous RK incisions may limit the options. Certainly the use of intraoperative measurements such as ORA can be helpful but still the precision isn’t perfect. Generally there are a few options for achieving the desired refractive outcome including wearing eyeglasses, corneal laser eye surgery such as LASIK or PRK, a lens implant exchange or a piggyback lens implant. Your previous RK may preclude you from LASIK for sure. You do not state whether the residual refractive outcome requires correction for nearsightedness, farsightedness and/or astigmatism. This too will be part of the decision on the likely usefulness of a piggyback lens implant as if there is irregular astigmatism-somewhat common with RK-you may not achieve your desired outcome. It is also not clear from your description why one would choose a piggyback over a lens exchange-either could be appropriate but your description precludes knowing the best choice. So-the best advice and opinion is to follow your cataract surgeon’s suggestion. That said, the complications of piggyback IOLs are similar to primary lens implants with the added risks of a second surgery-as long as the primary was uneventful.
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