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Clear lens extraction for the correction of high myopia
Luis Fernández-Vega1, José F Alfonso, Tomás Villacampa
1Ophthalmology Service, Asturias General Hospital, Oviedo, Asturias, Spain. cpa@telecable.es
Objective:
To evaluate the postoperative outcomes and intraoperative and postoperative complications of clear lens extraction (CLE) with posterior chamber intraocular lens (IOL) implantation in highly myopic eyes.
Design:
Retrospective case series.
Participants:
One hundred seven patients (190 eyes) who had undergone CLE with posterior chamber IOL implantation and who had been observed for at least 3 years after surgery.
Methods:
Medical records of patients who had undergone CLE with posterior chamber IOL implantation to treat high myopia (axial length >26.00 mm) over 7 years (January 1990 to December 1996) were reviewed. Visual acuity and refractive error were assessed before and after surgery, and perioperative, intraoperative, and postoperative complications were recorded.
Main Outcome Measures:
Axial length, preoperative and final best spectacle-corrected visual acuity (BSCVA), preoperative and postoperative spherical equivalent (SE), argon laser treatments, surgical complications, neodymium:yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy, retinal detachment (RD), time from surgery or Nd:YAG capsulotomy to RD, subfoveal choroidal neovascularization (CNV), and follow-up period.
Results:
The mean postoperative follow-up period was 4.78 years (range, 3.10-8.03 years). Final BSCVA was better than preoperative BSCVA in 159 eyes (83.68%), equal in 24 eyes (12.63%), and worse in 7 eyes (3.68%). Postoperative BSCVA was 20/40 or better in 136 eyes (71.60%) vs. 52 eyes (27.36%) before surgery (P<0.001). The mean final postoperative SE was -1.22 diopters. The risk of Nd:YAG laser capsulotomy was 77.89%. The incidence of RD was 2.10%; retinal reattachment was achieved in all cases, and none of these eyes had worse final BSCVA than before surgery. Subfoveal CNV developed in 4 eyes (2.10%) of 3 patients; all of these eyes presented with a macular lacquer crack.
Conclusions:
Clear lens extraction with posterior chamber IOL implantation has good outcomes with acceptable predictability and improvement in best-corrected visual acuity. During follow-up, patients tended to remain stable, and the risk of retinal detachment was low. We attribute our favorable results to careful patient selection and follow-up.