A 35 year woman underwent PRK operation in LE 10 years ago and now the refraction is -2. RE developed a congenital cataract : BCVA 20/40 with -6.5 -1 at 20.
Which is the best way to manage this case?
Sorry for the missing data : 20/20 with -2 sphere. ( of course remember that it is a myopic regression ) . The patient history says that the visual acuity in the RE was also 20/20 before the cataract development.
This is obvious and mandatory but I wanted to know how to manage in terms of refractive outcome considering the age and the refraction of the fellow eye.
You can find details of iol calculation http://iolcalc.ascrs.org/ website. I prefer low myopia this patient in postoperative period. For example -1.50 myopia. That is important that you find old records ( glass or contacts)
in terms of knowing the change in refraction over time. I do not think myopia is constantly increasing.
Myopic regression could be suggestive of subclinical cataract progression.
Specially after cataract history in the other eye.
I´ll aim for emmetropia in the right eye and wait 4 to 6 months hoping she could tolerate the "Monovision" (RE for distance, LE for close reading). If that´s so, In the future LE Phaco surgery could be planned for -1.5 residual refraction.
In theory, extracting the cataract is the right way to go and with the modern IOL calculation formula, previous PRK should not lead to refractive surprises. Still we must weigh the increased risks involved with high myopia (AL > 25 mm, ect.) against the non-surgical approach, i.e. correction with contact lenses.
Send me ([email protected]) pentacam and IOl calculation and I will calculate the IOL power needed to get emmetropia
I am not concern about the precision of the IOL calculation with the last generation formulas and topographic support. Just have in mind that at 35, she should appreciate some myopia in one of the eye for intermediate or near vision.
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