Refractive Management of Surgical-Induced Presbyopia in a Young Patient with Vision-Related Quality of Life Complaints: A Case Report

Visual difficulties can negatively impact life quality. Our purpose was to report the refractive surgical planning and outcomes of a young patient with mixed astigmatism and phacoemulsification-induced presbyopia due to congenital cataracts who was unsatisfied with her vision-related quality of life. A 32-year-old woman, submitted to phacoemulsification with implantation of a monofocal intraocular lens (IOL) and Nd:YAG laser posterior capsulotomy 3 years before, due to congenital cataracts, was referred to the Refractive Surgery Unit of Centro Hospitalar Universitario de Santo Antonio. She had mixed astigmatism (+1.00-4.00 x 10 degrees in the right eye [RE] and +0.50-1.75 x 180 degrees in the left eye [LE]) and surgical-induced presbyopia, was intolerant to contact lenses, and felt that her vision significantly impaired her life quality. A trifocal Sulcoflex (R) (Rayner) IOL was implanted to correct the spherical and near refractive errors. In a second surgical time, a photorefractive keratectomy was performed to correct the residual astigmatism (-3.50 x 10 degrees in the RE and -1.50 x 170 degrees in the LE). In the last visit, distance and near uncorrected visual acuity were 20/20 (Snellen) and Jaeger 1, respectively, in both eyes, and the patient was very satisfied. When assessing the surgical options of young, working-age patients, clinicians should, when possible, consider alternative solutions to monofocal IOLs. In this patient, the combination of corneal and intraocular procedures allowed the correction of both the distance and near refractive errors, with a subsequent significant improvement in the patient's quality of life.