Refractive lensectomy possible for hyperopes

MAUI, Hawaii — Refractive lensectomy with a multifocal implant is an alternative to refractive surgery for select presbyopic hyperopes and borderline cataract patients, said Frank A. Bucci Jr., MD.

“Some key factors include careful patient selection,” he told attendees here at Hawaii 2003: the Royal Hawaiian Eye Meeting. “You must also have accurate biometry and meticulous surgical technique.”

Dr. Bucci implanted 84 hyperopic eyes of 50 patients with the Array multifocal IOL (AMO) and performed astigmatic keratotomy at least 3 weeks later for patients with 0.75 D or more of astigmatism. All eyes were at least 20/40 postoperatively, with more than 90% at J2 or better for near vision.

The results demonstrated that hyperopic lensectomy with the Array multifocal implant is a safe and effective refractive procedure that provided patients with dramatic improvements in distance, intermediate and near vision. There was a high correlation between a strong preoperative desire for spectacle independence and postop success. Preop patient education and counseling regarding potential visual aberrations is critical in maximizing patient satisfaction.

“Managing the astigmatism is mandatory for patient satisfaction,” he said. Dr. Bucci prefers postoperative astigmatic keratotomy technique over an intraoperative technique. “I also prefer from the center of the cornea nomograms,” he added.

“Surgeons should avoid patients with unrealistic expectation, those who are obsessive/compulsive types, highly introspective people, people with high demands for near work or night driving and people who already complain of glare preoperatively,” he said.