Conductive keratoplasty: an approach for the correction of residual hyperopia in post-lasik pseudophakia.

Although there are many formulae for the calculation of intraocular lens power in the eyes with previous kerato-refractive surgeries, unexpected refractive bias still exists. Hyperopic bias is particularly disliked because it affects both uncorrected distance and near visual acuity. Surgical treatment of the residual hyperopia for the eyes with both laser in situ keratomileusis and cataract surgery remains to be a big problem. Conductive keratoplasty has been shown to be an effective, safe and predictable method for low and moderate hyperopia in the pseudophakic eyes or in the eyes with kerato-refractive surgeries. However, the efficacy and safety of conductive keratoplasty in the correction of residual hyperopia after both corneal and lens refractive surgeries has not been reported. Herein, we reported the surgical correction with conductive keratoplasty for cases of residual hyperopia with/without astigmatism after previous laser in situ keratomileusis for high myopia and following phacoemulsification combined with posterior intraocular lens implantation for complicated cataract.

[Conductive keratoplasty for presbyopia and two years follow-up].

OBJECTIVE: To investigate the effect of conductive keratoplasty (CK) for presbyopia and 2 years follow-up. METHODS: This study is prospective clinical trial. CK was performed on 34 patients for presbyopia, in which 26 hyperopic patients underwent binocular operations and 8 emmetropic patients underwent monocular operation. The following-up time was 24 months. RESULTS: At 24 months postoperatively, for the hyperopia group, binocular uncorrected near visual acuity (33 cm) (5-logMAR) (4.63 ± 0.12) was increased significantly (t = 9.237, P < 0.001) compared pre-operatively (4.06 ± 0.15); binocular uncorrected distance visual acuity (4.99 ± 0.02) was significantly increased (t = 6.718, P < 0.05) compared pre-operatively (4.82 ± 0.21); for the emmetropia group, binocular uncorrected near visual acuity (33 cm) (5-logMAR) (4.68 ± 0.16) was increased significantly (t = 10.413, P < 0.001) compared pre-operatively (4.13 ± 0.18); binocular uncorrected distance visual acuity was same as pre-operative one; compared pre-operatively (+0.97 ± 0.63D), manifest refractive spherical equivalent was decreased significantly (P < 0.001) to peak value (-1.21 ± 1.00) D at 1 week, and then regressed to a relative plateau (-0.40 ± 0.70) D at 24 months; the regressive rate was decreased from (+0.35 ± 0.44) D/month at 1 month postoperatively to (+0.01 ± 0.01) D/months at 24 months postoperatively. Contrast sensitivity and glare sensitivity, intraocular pressure, tear break-up time, endothelial cell count, central corneal thickness, stereopsis function and best corrected visual acuity were not significantly changed. CONCLUSIONS: For treatment of presbyopia, CK appeared to be safe, effective, refractive-predictable and controllable, and relatively stable at 24 months post-operatively. More long-time follow-up is necessary for further evaluation.