Small-aperture intraocular lens combined with secondary piggyback intraocular lens during cataract surgery after previous radial keratotomy

A 73-year-old woman with bilateral previous radial keratotomies (RK) and symptomatic cataracts was referred. The uncorrected distance visual acuity (UDVA) was 0.24 logarithm of the minimum angle of resolution (logMAR) in the left eye and 0.32 logMAR in the left eye. The American Society of Cataract and Refractive Surgery calculator for eyes with previous RK was used for intraocular lens (IOL) power calculation. The dominant left eye had uneventful cataract extraction with monofocal IOL implantation. For the nondominant right eye, a small-aperture posterior chamber IOL with the highest available power was used; this was followed by planned secondary piggyback sulcus IOL implantation for the expected residual refractive error. The UDVA after the primary procedure was 0.50 logMAR in the right eye and 0.10 logMAR in the left eye. After the planned secondary procedure, the UDVA was −0.10 logMAR in both eyes with a −0.50 diopter spherical equivalent and the patient did not require spectacles for near, intermediate, or distance vision.