Outcomes of Femtosecond Laser-Assisted Cataract and Refractive Lens Surgery in Patients with Prior Radial Keratotomy.

Purpose To investigate outcomes of femtosecond laser (FL-) assisted cataract surgery (FLACS) and refractive lens exchange (RLE) in patients with prior radial keratotomy (RK). Setting Single clinical practice. Design Retrospective observational case series. Methods All patients with prior RK undergoing FLACS- or FL-assisted RLE surgeries over a 6-year period were reviewed. Inclusion criteria were diurnal stability and stable manifest refraction. Exclusion criteria included any other incisional corneal surgery, macular or glaucomatous pathology, or vision loss from any other cause. Data collected included demographics, visual acuity, laser settings, and complications. Main outcome measures were intra- and postoperative complications and visual outcomes. Safety and efficacy indices were evaluated. Results Sixteen eyes of 9 patients were included. Average age and follow-up time were 59.9 ± 9.9 years (range 44-75 years) and 3.3 ± 2.5 months, respectively. Average number of RK cuts was 11.8 ± 5.3 (range 8-20). Mean preoperative UDVA and CDVA were 0.9 ± 0.4 logMAR (Snellen 20/160) and 0.2 ± 0.3 logMAR (Snellen 20/30), respectively. Two intraoperative anterior capsule (AC) tears were identified. One postoperative IOL dislocation occurred. Postoperatively, the mean UDVA and CDVA were 0.2 ± 0.2 logMAR (20/30) and 0.1 ± 0.1 logMAR (20/25), respectively. Safety index was 1.6 and efficacy index was 1.2. Conclusions FLACS- or FL-assisted RLE surgery in RK patients has a high risk of anterior capsule tear and should be avoided. Thickened incisional scars are potential sources of incomplete laser penetrance. Toric lens implantation in RK eyes provide unpredictable astigmatic correction and should also be avoided.