Case Report: Long-term visual rehabilitation in extreme early-onset axial myopia complicated by retinal detachment

Extreme early-onset axial myopia causes profound refractive disability and lifelong vitreoretinal vulnerability. We report approximately 20 years of follow-up in a woman with bilateral myopia of -8.00 diopters (D) at 1 year of age, axial lengths exceeding 30 mm at 6 years and 35 mm before adulthood. At 18 years, severe spectacle-related minification, peripheral distortion, and inconvenience persisted. After discussion of contact lenses, phakic intraocular lenses, and refractive lens exchange, she chose sequential bilateral refractive lens exchange with toric intraocular lenses and a residual myopic target of approximately -4.50 D. Eighteen days after right-eye surgery, she presented with a 3-day history of visual-field obscuration and was found to have a macula-off, multibreak rhegmatogenous retinal detachment. The eye underwent pars plana vitrectomy, endolaser photocoagulation, external cryotherapy, and silicone-oil tamponade; the oil was removed 5 months later. At the final visit, at 21 years of age, the axial lengths were 36.57 mm in the right eye and 36.17 mm in the left eye, and both retinas were attached. Visual acuity through the same-visit subjective refraction was logMAR 0.10 and 0.22 in the right and left eyes, respectively, whereas habitual spectacle-corrected visual acuity was logMAR 0.00 and 0.10. The patient reported improved daily visual function. This case shows that refractive lens exchange can reduce the optical burden of extreme myopic spectacles but does not remove the underlying vitreoretinal risk. It is a cautionary observation rather than a treatment recommendation and underscores individualized etiologic assessment, comparison of alternatives, conservative refractive targeting, peripheral retinal management, and lifelong surveillance.