This patient had prior radial keratotomy (RK) done in the early 1990s to address a modest degree of myopia. This worked well for a while but then drifted into progressive hyperopia and then about 15 years ago, LASIK was performed to return the eye to plano. The patient also has a weak corneal endothelium with cell drop out noted on microscopic examination. Now it is time for cataract surgery for this complicated case. Since so much RK was done in California decades ago, I have a lot of these patients, often multiple per week and my total experience is more than 1000 of these cases. How will you do the IOL calculations? What type of IOL would you implant? How can you ensure the health of the corneal endothelium? And what will be the appearance on post-op day 1? Comment below and then listen to my commentary to understand my take on these issues.
