Retinal detachment after cataract extraction and refractive lens exchange in highly myopic patients

To assess the refractive effects and incidence of postoperative complications in patients with high myopia after cataract extraction.

University Eye Clinic, Trieste, Italy.

This noncomparative retrospective study comprised all eyes (N = 388) having cataract extraction and implantation of an intraocular lens with a power less than 11.0 diopters (D) between 1986 and 1999. The preoperative and postoperative refractions; preoperative, postoperative, and final best corrected visual acuity (BCVA); and postoperative complications were analyzed. The mean follow-up was 47.16 months +/- 32.83 (SD) (range 8 to 146 months).

Phacoemulsification was performed in 237 eyes, extracapsular cataract extraction in 147 eyes, and intracapsular cataract extraction in 4 eyes. The mean preoperative BCVA was 0.20 +/- 0.21 and the mean postoperative BCVA, 0.58 +/- 0.32. At the final evaluation, the mean BCVA was 0.50 +/- 0.33. The mean refraction was -15.95 +/- 5.86 D preoperatively and -2.00 +/- 1.62 D postoperatively. One eye (0.26%) developed a retinal detachment postoperatively. Of the 127 eyes (32.73%) having a neodymium:YAG laser capsulotomy for posterior capsule opacification, 1 had a macular retinal hole. Posterior detachment of the vitreous occurred in 78.6% of cases. Peripheral retinal photocoagulation was required in 8 cases postoperatively.

Refractive lens exchange led to good functional results and a low incidence of postoperative complications and can thus be regarded as a viable technique to correct high myopia associated with cataract. However, further study is required before it can be routinely recommended for the correction of high myopia in eyes with a transparent crystalline lens.