Refractive Surgery


Prof. (Dr.) Rajesh Sinha
Professor, Dr. RP centre for
Ophthalmic Sciences, AIIMS,
New Delhi, india

Isotretinoin may not be a contraindication for keratorefractive surgery
Ortega-Usobiaga et al evaluated the functional outcomes of laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) in patients taking isotretinoin, a drug which is considered a contraindication for these procedures. In a multicentre, retrospective, interventional case series, they evaluated all consecutive patients currently taking isotretinoin who underwent LASIK or PRK in a 15 year period with those undergoing LASIK or PRK who had taken isotretinoin previously but not in the previous 6 months. The study enrolled a total of 113 patients (219 eyes) in both groups. The groups were found to be similar in terms of visual acuity, postoperative spherical equivalent, efficacy index, predictability, or safety index. The authors noted that LASIK and PRK can be performed effectively and safely in selected patients taking isotretinoin and therefore suggested that it should not be an absolute contraindication.

Further reading:
Ortega-Usobiaga J, Llovet-Osuna F, Djodeyre MR, Bilbao-Calabuig R, González- López F, Llovet-Rausell A, Druchkiv V. Outcomes of laser in situ keratomileusis and photorefractive keratectomy in patients taking isotretinoin. Am J Ophthalmol. 2018 May 14. pii: S0002-9394(18)30219-8. doi:10.1016/j.ajo.2018.05.009. [Epub ahead of print]

FLACS after Phakic IOLs
Steinwender G et al reported the efficacy, predictability, and safety of femtosecond laser-assisted cataract surgery (FLACS) in eyes with anterior chamber phakic intraocular lenses (IOLs). In a retrospective case series which included eyes with previous implantation of an angle-supported and an iris-fixated phakic IOL for the correction of myopia that underwent a combined procedure of phakic IOL ex-plantation and FLACS with in-thebag implantation of a posterior chamber IOL, the authors evaluated various parameters including postoperative corrected distance visual acuity (CDVA), predictability of refractive outcome, and occurrence of intraoperative and postoperative complications. The series included 10 eyes of 7 patients with significant cataract, 5 eyes with an angle-supported foldable hydrophobic phakic IOL, 4 eyes with an anglesupported polymethylmethacrylate (PMMA) phakic IOL, and 1 eye with an iris-fixated PMMA phakic IOL. The mean follow-up after FLACS was 8.4 ± 5.8 months and mean interval between phakic IOL implantation and FLACS was 11.9 ± 4.0 years. After the combined procedure of phakic IOL explantation and FLACS, mean manifest refractive spherical equivalent (MRSE) was -0.11 ± 0.49 diopters (D) and MRSE was within ± 0.75 D of target refraction in all eyes. Four eyes received a toric PCIOL after phacoemulsification. Mean preoperative CDVA was 0.40 ± 0.23 logMAR which improved significantly to 0.22 ± 0.11 logMAR postoperatively (P = .027). No intraoperative or postoperative complications occurred. The authors concluded that FLACS in eyes with previous implantation of both rigid and foldable anterior chamber phakic IOLs offered good refractive outcomes with a high level of predictability and safety.

Further reading:
Steinwender G, Shajari M, Kohnen T. Refractive Outcomes After Femtosecond Laser-Assisted Cataract Surgery in Eyes With Anterior Chamber Phakic Intraocular Lenses. J Refract Surg. 2018 May 1;34(5):338-342.