Cataract surgery following KAMRA presbyopic implant
Case 2, a 62-year-old Chinese male, underwent implantation of the KAMRA corneal inlay in the nondominant left eye on July 4, 2007. A 9.00 mm-diameter lamellar flap was created at a depth of 151 microns with a SCHWIND microkeratome (SCHWIND, Kleinostheim, Germany). The corneal inlay was implanted without complication. The patient’s pre- and 1-month postoperative visual acuity results can be found in .\nFour years after KAMRA implantation, cataract of grade NC2 (LOCS III) was noted in the implanted left eye. Nevertheless, vision in this eye remained good; UDVA was 20/20−1 and UNVA was J2. However, 6 years after KAMRA implantation, the patient felt that his distance vision in the left eye had deteriorated significantly () and, on assessment, cataract of grade NC4 (LOCS III) was noted. AcuTarget photographs confirmed that the implant was well centered (inlay vs Purkinje: −146 μm x, −78 μm y). Various treatment options were presented to the patient, who opted for cataract surgery, leaving the KAMRA implant in place. Biometry parameters used are listed in .\nThe patient underwent phacoemulsification and intraocular lens implantation of the left eye under local anesthesia. A 2.60 mm temporal clear corneal incision was made, and a +20.0 D monofocal Tecnis ZCB00 intraocular lens was implanted. No modifications were made to the surgical technique, and the surgeon reported no difference in ease of the surgery with the KAMRA implant in place, except that some extra ocular rotations during capsulorhexis and phacoemulsification to optimize the surgical view were required. Surgical time was 15 minutes, and there were no intraoperative or early postoperative complications. The objective visual outcome 1 month after cataract surgery is reported in . The subjective outcome was also good. The patient reported good near, intermediate and distance vision without the use of spectacles, and remains spectacle-independent.