Management of cataract surgery in a high myope

Efficacy of Toric intraocular lens implantation in eyes with high myopia: A prospective, case-controlled observational study

The present prospective clinical observational study aimed to evaluate the efficacy of Toric intraocular lenses (IOL) to achieve rotational stability and astigmatism correction in eyes with high myopia. A total of 27 consecutive cataract patients (39 eyes) with pre-existing corneal astigmatism (1.5–3.5 D) were divided into two groups according to their refractive status: One group of 18 eyes with high myopia -(12.5–6.0 D) and another group consisting of 21 eyes with emmetropia or low myopia (−3.0–0.0 D). All eyes underwent cataract phacoemulsification surgeries by the same surgeon, with the implantation of an AcrySof^® Toric IOL at the pre-designed degree. Uncorrected visual acuity, best corrected visual acuity and phoropter examination results were recorded at the 1st day, 1st week, 1st month and 3rd month after the surgery. By analyzing digital images from slim-lamp photography with a self-designed software, the rotational stability was observed. The contrast sensitivity was also measured. No significant difference in the baseline and post-operative residual astigmatism was identified between the two groups (P>0.05). In addition, no significant difference in the degree of rotation was observed between the two groups. All patients had significantly improved visual quality after the surgery (P<0.05). In conclusion, the present study observed an equal astigmatism-correction efficiency and rotational stability in the two groups. A second auxiliary spot-penetrating incision, removal of visco-elastic substances and tight adherence of the IOL to the posterior capsular membrane are essential for a successful surgery.

Cataract surgery in the setting of severe pathologic myopia with high axial length: use of pars plana lensectomy and vitrectomy

Cataract surgery in patients with pathologic myopia and high axial length can be challenging for a variety of reasons, including imprecise intraocular lens calculations in eyes with posterior staphylomas and intraoperative complications such as suprachoroidal hemorrhage, posterior capsular rupture, and retinal tears. Although most surgeons recommend standard phacoemulsification and preservation of the posterior capsule in these cases, an alternative approach presented in this series entails the removal of the lens through the pars plana and removal of formed vitreous during the concurrent procedure.

Clear lens phacoemulsification combined with vitrectomy to correct high myopia: four years of follow-up

PURPOSE

To evaluate the outcome, intraoperative and postoperative complications of refractive lens exchange (RLE) by phacoemulsification with posterior chamber intraocular lens (IOL) implantation combined with simultaneous pars plana vitrectomy (PPV) in the management of high myopia.

METHODS

This prospective study consisted of 45 eyes of 26 patients with preoperative myopia greater than -12.5 dpt. Clear lens phacoemulsification with IOL implantation surgery was combined with PPV. Main outcome measures were best-corrected visual acuity (BCVA), stability of the spherical equivalent (SE) and complications at follow-up.

RESULTS

The combined procedure of clear lens phacoemulsification combined with PPV has a favorable outcome with acceptable SE predictability and improvement in BCVA. The postoperative BCVA was 0.67 ± 0.21 compared to 0.15 ± 0.10 preoperatively (p < 0.001). The mean postoperative SE was -1.6 ± 0.9 dpt, showing a significant difference when compared with a mean value of -20.0 ± 5.2 dpt before the operation (p < 0.001). During the follow-up, all IOLs were placed stably in the bag with no capsular tear occurring and only 1 case (2.2%) developed retinal detachment.

CONCLUSION

RLE and implantation of an IOL combined with simultaneous PPV is a reasonable refractive surgery option for middle-aged patients with high myopia.

A comparative study of complications of cataract surgery with phacoemulsification in eyes with high and normal axial length

Background:

This study performed to assess the safety of cataract extraction with phacoemulsification and intraocular lens (IOL) implantation in patients with high axial length compared with patients with normal axial length.

Materials and Methods:

A total of 866 eyes were enrolled in this study; all subjects underwent phacoemulsification and IOL implantation for treatment of cataract. Seven hundred and nine eyes fell in the normal group with axial lengths ranging between 21 and 24.5 mm, and 157 eyes were considered myopic with axial length equal or greater than 26 mm. The two groups were compared regarding intraoperative surgical complications, such as vitreous loss, posterior capsular rupture, nucleolus drop, and undesirable implantation of IOL in the anterior chamber.

Results:

Age was a risk factor in both groups, with each year increase of age, the chance of incidence of intraoperative complications increased 1.04-folds (P = 0.03). And with 1 mm increase in axial length, the incidence of complications raised 1.22-folds (P = 0.007). There was no significant correlation between axial length and incidence of vitreous loss, although the incidence of posterior capsular rupture and nucleus fragment drops increased with increment in the axial length. Sex of the patients and side of the left or right eye were not found to be significant risk factors.

Conclusions:

As the results illustrate, in this survey, age and high axial length were statistically significant risk factors for incidence of intraoperative complications of cataract surgery with phacoemulsification technique. Anticipation of these complications and also preparation and prophylactic measures may decrease incidence of these complications.

Percaruncular single injection peribulbar anaesthesia in patients with axial myopia for phacoemulsification

BACKGROUND

Myopia has been identified as a risk factor for globe perforation during regional anaesthesia for cataract surgery. We conducted this study to evaluate efficacy of single injection percaruncular peribulbar anaesthesia for phacoemulsification in patients with axial myopia.

METHODS

Eighty patients with axial myopia received percaruncular peribulbar anaesthesia and were evaluated for incidence of major or minor complications. Also surgeon and patients' satisfaction and their comment on operative conditions were noted.

RESULTS

Of the 80 patients 51 patients had posterior staphylomas. About three quarters of the patients developed adequate akinesia in 10 min. Remaining 25% received second injection with the same technique but with less volume after which the percent of patients with adequate akinesia rose to 91%. Adequate analgesia developed in almost all patients and only in one patient, intravenous analgesia was necessary to complete the operation. All operations were completed uneventfully. No perforations or penetrations were recorded and no other major complications were encountered. About 97% of the surgeons and 96% of the patients found the operative conditions satisfactory.

CONCLUSION

Using single injection percaruncular peribulbar local anaesthesia for phacoemulsification in patients with axial myopia is an effective technique.

Phacoemulsification and intraocular lens implantation in eyes with long axial length

We evaluated the results of phacoemulsification and intraocular lens implantation in 414 eyes with long axial length and classified them according to axial length (AL): Group A: AL: 25-28 mm, Group B: AL >28 mm. Intraoperative maneuvers, pre- and postoperative photocoagulation for predisposing retinal lesions and retinal detachment rates were significantly higher in Group B than Group A. Eyes with an axial length over 28 mm are prone to more problems when compared to those with an axial length between 25 and 28 mm.

Refractive lens exchange combined with pars plana vitrectomy to correct high myopia

PURPOSE

To describe the results of refractive lens exchange (RLE) combined with simultaneous pars plana vitrectomy (PPV) in the management of severe myopia.

METHODS

This retrospective study comprised 14 eyes of eight patients who had RLE to treat myopia of -19.0+/-5.4 diopters (D). Phacoemulsification, posterior chamber intraocular lens (IOL) implantation, and standard three-port vitrectomy were performed. Mean postoperative follow-up time was 30 months (range 12-49).

RESULTS

The postoperative best-corrected visual acuity (BCVA) was 0.68+/-0.23 compared to 0.37+/-0.24 preoperatively. There was no postoperative decrease in visual acuity in any eye. Mean postoperative spherical equivalent was -0.7 D (+/-1.6). At 30 months mean follow-up time, the spherical equivalents of nine eyes (64.3%) were within +/-1 D of emmetropia. There was no significant change in astigmatism due to operative procedures. During the 30 months follow-up period three eyes (21.4%) required neodymium : yttrium-aluminium-garnet (Nd : YAG) capsulotomy for posterior capsule opacification. No retinal detachments or cases of cystoid macular oedema (CME) were observed during the follow-up.

CONCLUSION

RLE was effective in correcting severe myopia. The simultaneously performed PPV may reduce the risk of postoperative retinal detachment. This was a pilot study, to draw definitive conclusions a prospective study has to be initiated.

Resulting refraction after same-day bilateral phacoemulsification

PURPOSE

To study the refraction achieved after same-day bilateral cataract surgery, particularly with regard to anisometropia and the incidence of patient dissatisfaction caused by this complication.

SETTING

Department of Ophthalmology, University Hospital of Linköping, Sweden.

METHODS

This was a retrospective study of 165 consecutive patients who had bilateral cataract surgery on the same day. Parameters examined were preoperative and postoperative visual acuity and refraction (spherical equivalent), preoperative keratometry and axial lengths, planned postoperative refraction, difference between planned and achieved refraction, anisometropia, and recorded evidence of patient dissatisfaction resulting from refraction or binocularity problems.

RESULTS

Postoperative refraction was within +/-0.5 diopter (D) from target in 43%, +/-1 D from target in 71%, and +/-2 D from target in 95% of eyes. Anisometropia was < or =0.5 D in 48% of patients and < or =1 D in 82% of patients. Two patients (1.2%) had anisometropia >2 D. No patient returned with complaints caused by postoperative refraction.

CONCLUSIONS

Although deviation from planned postoperative refraction occurred in several cases, no patient reported binocularity problems in the 1% of cases with significant anisometropia. Risk for deviation from planned refraction does not appear to be a contraindication to same-day bilateral phacoemulsification in patients without known risk factors.