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

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.