Intraocular aphakia correction in patients with prior of keratorefractive surgery: literature review. Part 2

Introduction. In clinical practice, cataract surgeons are increasingly encountering patients with a history of keratorefractive surgery. According to various studies, one of the key challenges in achieving the desired refractive outcome for these patients is selecting the appropriate formula for intraocular lens (IOL) power calculation. The second part of this review explores the application of different formulas for calculating IOL power, with a focus on specific challenges and potential errors in IOL selection for aphakia correction following previous keratorefractive procedures. The purpose of this second part is to address the issue related to IOL selection and calculation in patients post-keratorefractive surgery, considering clinically significant optical effects and the condition of the anterior surface of the eye, which can influence both postoperative refraction and the duration of the postoperative rehabilitation period. Materials and methods. A review of peer-reviewed publications from the past 30 years was conducted using databases such as PubMed, eLibrary, CyberLeninka, Science Direct, and Google Scholar. The review analyzed 32 articles, predominantly from the last decade. This study provides a detailed analysis of the scientific literature, highlighting the influence of prior keratorefractive surgeries on the success of phacoemulsification with IOL implantation. Results of this second part of the review suggest that using multiple IOL calculation formulas yields more accurate refractive outcomes, minimizing postoperative refractive errors. Additionally, the analysis of IOL selection criteria highlights that IOLs with extended depth of focus (EDOF) demonstrate greater tolerance to decentration, pupil size variations, and higher-order aberrations, facilitating patients adaptation to improved visual quality following cataract surgery. Early diagnosis and effective treatment of underlying dry eye syndrome (DES) can further reduce errors during preoperative diagnostics and enhance patient satisfaction in the post-operative period. Conclusion. Taken together, both parts of this article provide a comprehensive review that, for the first time, brings together key fundamental and clinical aspects of aphakia correction in patients with a history of keratorefractive surgery. Understanding these factors will assist ophthalmic surgeons in selecting optimal treatment strategies to achieve the best possible clinical outcomes for these patients.

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