Cataract surgery following KAMRA presbyopic implant
Case 1, a 53-year-old Chinese male, underwent implantation of the KAMRA corneal inlay in the nondominant left eye on January 6, 2010. A 7.80 mm-diameter lamellar flap was created at a depth of 190 microns with a VisuMax™ femtosecond laser (Carl Zeiss Meditec, Jena, Germany). The corneal inlay was implanted without complication. The patient’s pre- and 1-month postoperative visual acuity results can be found in . A slit-lamp photograph of the KAMRA corneal inlay in place is shown in .\nTwelve months after implantation, even though reading well, the patient noted ghosting and slight monocular diplopia in the left eye. This was felt to be due to the position of the KAMRA inlay. The patient underwent surgical repositioning of the implant, resulting in resolution of his symptoms. shows AcuTarget™ (AcuFocus) photographs of the KAMRA implant positioning before and after surgical repositioning.\nSeven months after repositioning of the implant, the patient had an UNVA of J10 and was noted to have developed cataract of grade NC3P3 (LOCS III) in the left eye. Various options were discussed with the patient, including cataract surgery with the implant in place, removal of the implant followed by cataract surgery and subsequent re-implantation, and implant removal followed by cataract surgery with a multifocal or accommodative intraocular lens implant. Centration of the KAMRA implant was confirmed with AcuTarget photographs (). Due to the excellent centration (inlay vs Purkinje: −95 μm x, −27 μm y), the patient opted for cataract surgery, leaving the KAMRA implant in place. Biometry parameters are summarized in . Corneal topography remained stable after implantation of the KAMRA inlay and before cataract surgery ().\nThe patient underwent uncomplicated phacoemulsification and intraocular lens implantation of the left eye under local anesthesia. A 2.60 mm temporal clear corneal incision was made, and a +22.0 D monofocal Tecnis® ZCB00 intraocular lens (Abbott Medical Optics, Santa Ana, CA, USA) was implanted. No modifications were made to the surgical procedure, and the surgeon reported no difference in the ease of surgery with the KAMRA implant in place, apart from a few extra ocular rotations during capsulorhexis and phacoemulsification to improve visualization. There were no intraoperative complications, and surgical time was 15 minutes. Slit-lamp photographs taken after cataract surgery can be seen in . One month after cataract surgery, posterior capsular opacification was noted in the left eye, and the patient underwent Nd:YAG laser capsulotomy 6 weeks after cataract surgery (). The objective visual outcome 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.