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LASIK-lens combination allows multifocal IOL use in astigmatic patients

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LONDON — Refractive lens exchange combined with LASIK can extend the indications for using a multifocal IOL to include patients with astigmatism, according to a surgeon speaking here.

Pierre Levy, MD, of Clinique Saint Roch in France presented his approach to managing existing astigmatism and presbyopia using astigmatic LASIK after implantation of the Alcon AcrySof ReSTOR multifocal lens. The study was extracted from his clinical experience with 150 eyes, he said.

"The use of LASIK to correct preoperative astigmatism is a good means to extend the indications to patients whose astigmatism, until now, was a contraindication for a ReSTOR implantation," Dr. Levy said. "Our study shows a bioptic approach is a good option in patients with corneal astigmatism between 1.5 D and 4 D."

Dr. Levy reviewed his results in 24 eyes of 12 patients with corneal astigmatism between 1.5 D and 4 D in whom he implanted the ReSTOR. All patients were older than 54 years, and preoperative ametropia ranged from –2 D to +3 D.

Surgery was performed in two stages, beginning with clear lens exchange followed by LASIK after 3 months, Dr. Levy said. Eyes with astigmatism greater than 1.25 D should be targeted for slight myopia when the refractive lens exchange is performed, he said.

At the 3-month follow-up, spherical refraction ranged from –0.5 D to +0.75 D, and all patients were within 1 D of emmetropia by 6 months' follow-up. Residual cylinder ranged from –0.25 D to 0.5 D, uncorrected visual acuity for distance ranged from 20/25 to 20/20 and uncorrected near visual acuity ranged from J3 to J1.