Modern Phacoemulsification and Intraocular Lens Implantation (Refractive Lens Exchange) Is Safe and Effective in Treating High Myopia

Abstract

Improved efficacy, predictability, and safety of modern phacoemulsification have resulted in cataract surgery being considered as a refractive procedure. Refractive lens exchange by definition is a surgery aimed at replacing the cataractous or clear crystalline lens with an intraocular lens (IOL) in cases of high ametropia. The excellent intraocular optics of this procedure provide a better visual outcome as compared with laser refractive surgery in high myopia. With advances in technology and IOL formulas, the predictability of refractive outcome after cataract surgery in high myopes has improved. The option of addressing presbyopia using multifocal/accommodating IOLs or monovision results in patients achieving reasonable spectacle independence. The most important concern with respect to phacoemulsification in high myopia is the risk of pseudophakic retinal detachment. High myopia is an independent risk factor for retinal detachment, and recent publications have reported a much lesser risk of retinal detachment specifically attributable to phacoemulsification in high myopes, especially if a thorough posterior segment evaluation is done and patients are followed up until development of complete posterior vitreous detachment. Refractive lens exchange is an effective and safe option to correct high myopia and can significantly improve quality of life in select patients.

<p>Implantation of a Trifocal Intraocular Lens in High Myopic Eyes with Nasal-Inferior Staphyloma</p>

“…About 1 line of better visual acuity is found in long eyes. Focusing on the post-surgery cumulative CDVA, the long eye group showed an 80% of eyes (20) with 20/20 and the nasal-inferior staphyloma group a low percentage: 20% (5 eyes). Long eyes achieved a 100% of eyes with the same cumulative CDVA in 20/25 and nasal-inferior staphyloma eyes achieved this percentage in a low value: 20/32 (see Figure 2C).…”

Surgical Correction of Myopia

“…The improved efficacy, predictability, and safety of modernday phacoemulsification have resulted in a resurgence of lens extraction as a modality for correction of high myopia. Increased numbers of RLE are being performed worldwide, especially in patients not suitable for LASIK or pIOL or with early lens changes in the presbyopia age group [80,81]. Optics of the IOL confer better quality of vision as compared with LASIK, and this optical quality does not degrade with time except in the presence of a posterior capsular opacification.…”

“…Inclusion criteria are more than 40 years of age with myopia not amenable to conventional laser refractive surgery (e.g., high refractive error, corneal irregularities, thin cornea) or phakic IOLS (e.g., shallow anterior chamber, poor endothelial cell count, early cataract changes), presbyopic myopic patients who want reasonable independence from glasses for both distance, and near-vision, myopic patients with early lens changes who desire refractive correction [80,86]. For multifocal IOL it is important to rule out any irregularities of iris or pupil function, evolving retinal pathology, absence of uveitis, or any kind of ocular inflammation.…”

“…The commonest disadvantage is the loss of accommodation with the need for near-vision glasses in the cases of monofocal IOL and the inherent risk associated with intraocular surgery, especially in high myopes [80]. The risk for endophthalmitis in general cataract surgery with implantation of a posterior chamber IOL is 0.1-0.7% with an optimal antiseptic perioperative treatment regimen [87].…”

“…and it is prudent to perform OCT preoperatively in all RLE patients, especially those with more than 10 D of myopia. The presence of a myopic CNVM in the fellow eye is also considered as a risk factor for developing CNVM in the operated eye [80,94].…”