Management of presbyopic patients with previous corneal refractive surgery: Phenotype-driven considerations and functional classification.

Abstract

Purpose: To review the available evidence on simultaneous-vision intraocular lens (SVIOL) implantation in eyes with previous corneal refractive surgery (CRS), considering the interaction between corneal phenotype and the functional depth-of-field (DOFi) classification of intraocular lenses.

Methods: Narrative literature review evaluating clinical outcomes of SVIOL implantation in eyes with prior CRS, including myopic and hyperopic LASIK/PRK, SMILE, and radial keratotomy. Full-DOFi and Partial-DOFi lenses were compared regarding refractive predictability, visual quality, spectacle independence, and sensitivity to residual aberrations.

Results: Refractive predictability remained lower in post-CRS eyes, particularly after hyperopic ablations and radial keratotomy. Full-DOFi lenses provided superior near vision and higher spectacle independence rates in selected myopic LASIK eyes, although they appeared more sensitive to residual aberrations. Evidence regarding Partial-DOF lenses mainly derives from extended-depth-of-focus and multifocal designs, with limited data for other subclasses. Available studies suggest greater optical tolerance and a lower burden of photic phenomena, potentially at the expense of near visual performance, but the evidence is limited. Evidence in SMILE and radial keratotomy remains scarce and heterogeneous.

Conclusions: Careful patient selection based on corneal phenotype and comprehensive preoperative assessment are essential in post-CRS patients. Biometric predictability remains the main limiting factor in optimizing refractive outcomes with SVIOL implantation.