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Phaco-refractive surgery sometimes the best option
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COSTA DO SAUIPE, Brazil — Phaco-refractive surgery may be a viable option for patients in whom standard LASIK is not recommended, said Rui Marinho, MD.
“Our concept of phaco-refractive surgery is the replacement of a (natural) lens that, although clear, is functionally insufficient for the correction of the ametropia in question and that has lost half of its accommodative power,” Dr. Marinho said during a presentation here at the Brazilian Congress of Cataract and Refractive Surgery.
Dr. Marinho recommends a combined phaco-refractive procedure for patients over the age of 45 or whose refractive errors are beyond the limits of LASIK.
“We recommend it for myopes above 12 D, corneas with thickness below 480 µm, corneas with more than 38 D in central curvature, refraction varying less than 10% in the past 2 years, and absence of keratoconus,” he explained. In hyperopia, he said, the surgery is indicated for patients with more than 6 D of error, initial corneal curvature less than 48 D, corneal thickness below 480 µm, stable refraction, and an absence of tendency to keratoconus.
Dr. Marinho said he has found patients with high refractive errors are highly motivated but extremely skeptical and insecure about surgery.
“Generally there is an accentuated anisometropia after the surgery on the first eye if the patient doesn’t use contact lenses. The patient will only be willing to be operated on by you if he trusts you or if you come highly recommended,” Dr. Marinho said.
Dr. Marinho said this procedure is safe and efficacious for high ametropes, especially patients with high hyperopia.
“In our study we used temporal clear cornea incision with topical anesthesia, 3.2 mm to 5.5 mm, with or without suture and parsimonious use of ultrasound, foldable and nonfoldable lenses, depending on the patient’s situation,” he explained.