Visual Outcomes After Sequential Posterior Chamber Phakic IOL with Corneal Refractive Surgery (Bioptics) for the Treatment of Myopic Astigmatism

Purpose: To report the outcomes of sequential posterior chamber phakic intraocular lens (PCpIOL) with corneal refractive surgery in conventional (PC-pIOL prior to refractive surgery) and reverse (refractive surgery prior to PC-pIOL) bioptics for treating high myopic astigmatism. Setting: Tertiary refractive center, Draper, Utah, USA. Design: Retrospective case series. Methods: Medical records of patients who underwent planned bioptics were reviewed. Surgery involved PC-pIOL placement using an implantable collamer lens (ICL) with preceding or subsequent LASIK or PRK. Preand postoperative manifest spherical equivalent (SEQ), visual acuity, and PC-pIOL vault were analyzed. Results: Of the 51 eyes present at 12 months postoperatively, 49 eyes (96%) achieved target SEQ within +/- 1.00 D and an identical amount achieved refractive astigmatism <= 1.00 D. Postbioptics eyes achieved a postoperative UDVA equal to or better than preoperative CDVA in 45 eyes (88%). Efficacy and safety indices were 1.08 +/- 0.20 (41 eyes) and 1.13 +/- 0.22 (44 eyes) for conventional bioptics and 0.99 +/- 0.42 (7 eyes) and 1.15 +/- 0.38 (7 eyes) for reverse bioptics eyes at 12 months. The maximum PC-pIOL vault of conventional bioptics eyes (27 eyes) within 6 months before and after LASIK/PRK was 385 +/- 159 mu m and 377 +/- 135 mu m, respectively (P = 0.71). Conclusion: Bioptics for high myopic astigmatism was safe and effective. Reverse bioptics, although not as traditional, could provide similar results. Additionally, the PC-pIOL vault does not appear to be affected by LASIK/PRK.