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

To report the outcomes of sequential posterior chamber phakic intraocular lens (PC-pIOL) 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. Tertiary refractive center, Draper, Utah, USA. Retrospective case series. 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. Pre- and postoperative manifest spherical equivalent (SEQ), visual acuity, and PC-pIOL vault were analyzed. 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. Post-bioptics 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 μm and 377 ± 135 μm, respectively (P = 0.71). 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.