1
|
Alio JL, Pederzolli M, Grzybowski A. Refractive lens exchange: What are the red lines? Eur J Ophthalmol 2024; 34:317-322. [PMID: 38062638 DOI: 10.1177/11206721231218909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Practical advancements in phacoemulsification techniques and intraocular lenses and the wide availability of phacoemulsification machines have led refractive lens exchange (RLE) to increase in popularity. Ethical boundaries in RLE have subsequently been pushed to include patients at higher risk of complications. In this editorial, we consider RLE outcomes and complications per type of refractive error, together with preoperative, intraoperative and postoperative ethical obligations for refractive surgeons. In the conclusions section, we propose an algorithm for ethics-guided indications to RLE.
Collapse
Affiliation(s)
- Jorge L Alio
- Research and Development Department, VISSUM Miranza, Alicante, Spain
- Division of Ophthalmology, Pathology and Surgery Department, Universidad Miguel Hernández, Alicante, Spain
| | - Matteo Pederzolli
- Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| |
Collapse
|
2
|
Rodríguez-Calvo-de-Mora M, Rocha-de-Lossada C, Rodríguez-Vallejo M, Zamora-de-la-Cruz D, Fernández J. Retinal detachment after refractive lens exchange: A narrative review. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:507-520. [PMID: 37364678 DOI: 10.1016/j.oftale.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
Refractive lens exchange (RLE) allows to correct ametropias and presbyopia by replacing the crystalline lens with an extended depth of focus or multifocal intraocular lens (IOL). Retinal detachment (RD) is one of the most serious adverse events after RLE. This study aimed to review the evidence related to the risk of RD after RLE and clinical outcomes. A search using PubMed and a snowball search approach was conducted to identify articles and case reports. According to the literature, the risks of RD should be considered in patients <60 years old with axial lengths >23 mm. Only nine articles reported visual acuity (VA) after RD in RLE, and only 25% of eyes had a VA > 20/40. Considering that the decrease in VA might be uniform for all types of IOLs after RD, surgeons should focus on selecting the patient to prevent RD rather than on a particular IOL optical design based on the potential risk of DR.
Collapse
Affiliation(s)
- M Rodríguez-Calvo-de-Mora
- Qvision, Departamento de Oftalmología, VITHAS Almería Hospital, Almería, Spain; Departamento de Oftalmología, VITHAS Málaga, Málaga, Spain; Departamento de Oftalmología, Hospital Regional Universitario Málaga, Málaga, Spain.
| | - C Rocha-de-Lossada
- Qvision, Departamento de Oftalmología, VITHAS Almería Hospital, Almería, Spain; Departamento de Oftalmología, VITHAS Málaga, Málaga, Spain; Departamento de Oftalmología, Hospital Regional Universitario Málaga, Málaga, Spain; Departamento de Cirugía, Área de Oftalmología, Universidad de Sevilla, Sevilla, Spain
| | - M Rodríguez-Vallejo
- Qvision, Departamento de Oftalmología, VITHAS Almería Hospital, Almería, Spain
| | - D Zamora-de-la-Cruz
- Departamento de Segmento Anterior, Instituto de Oftalmología Fundación Conde de Valenciana, Mexico City, Mexico; Departamento de Segmento Anterior, Hospital Mexiquense de Salud Visual, ISEM, Naucalpan de Juárez, Mexico
| | - J Fernández
- Qvision, Departamento de Oftalmología, VITHAS Almería Hospital, Almería, Spain
| |
Collapse
|
3
|
Joshi RS. Clear lens extraction for patients who are unfit for laser-assisted in situ keratomileusis and implantable contact lenses in central Indian population. Indian J Ophthalmol 2020; 68:3002-3005. [PMID: 33229686 PMCID: PMC7856966 DOI: 10.4103/ijo.ijo_1307_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose: The purpose of this study is to establish the safety of clear lens extraction (CLE) for the correction of high myopia in patients unfit for implantable contact lenses (ICLs) and laser in situ keratomileusis in the central Indian population. Methods: In this retrospective observational study performed at a tertiary care centre, medical records of the patients who had undergone CLE with implantation of intraocular lens (IOL) to treat high myopia were retrieved. Details of the demographic profile, surgical procedure, complications, power, and type of IOLs implanted were recorded. Results: The average postoperative follow-up period was 64.1 ± 4.2 months. The average postoperative spherical power was −1.4 ± 0.6 D, which was much lower than the preoperative spectacle power - 15 ± 4.4 D. There was improvement in the postoperative visual acuity (0.4 ± 0.2 logMAR) from the preoperative distant uncorrected visual acuity (0.8 ± 0.2 logMAR). No significant change in intraocular pressure (IOP) was observed. The postoperative average anterior chamber depth (ACD) (2.66 ± 0.1 mm) was significantly deeper than the preoperative ACD (2.61 ± 0.1 mm) P = 0.00. Barrage laser was required for lattice degeneration in one patient before CLE and in two patients during follow-up. Two patients (8.7%) required Nd:YAG capsulotomy for posterior capsular opacification. None of the patients had corneal decompensation, retinal detachment, or endophthalmitis. Conclusion: CLE with implantation of IOL is the safe procedure for correcting high myopia in patients who are unfit for ICL. None of the patient had eye loss in the follow-up period of 5 years. The low incidence of complications can be attributable to the closed chamber lens removal and implantation of IOL and prophylactic retinal treatment.
Collapse
Affiliation(s)
- Rajesh Subhash Joshi
- Department of Ophthalmology, Government Medical College, Nagpur, Maharashtra, India
| |
Collapse
|
4
|
Paysse EA. Anisometropic Amblyopia: The Potential Role of Keratorefractive Surgery. ACTA ACUST UNITED AC 2017. [DOI: 10.3368/aoj.57.1.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
5
|
Paysse EA. Refractive Surgery in Children: Is it Ready for Prime Time? ACTA ACUST UNITED AC 2017; 57:79-88. [DOI: 10.3368/aoj.57.1.79] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
6
|
Srinivasan B, Leung HY, Cao H, Liu S, Chen L, Fan AH. Modern Phacoemulsification and Intraocular Lens Implantation (Refractive Lens Exchange) Is Safe and Effective in Treating High Myopia. Asia Pac J Ophthalmol (Phila) 2017; 5:438-444. [PMID: 27898449 DOI: 10.1097/apo.0000000000000241] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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.
Collapse
Affiliation(s)
- Bhaskar Srinivasan
- From the *C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China; †Sankara Nethralaya, Chennai, India; and ‡Dennis Lam & Partners Eye Center, Hong Kong
| | | | | | | | | | | |
Collapse
|
7
|
Alió JL, Grzybowski A, Romaniuk D. Refractive lens exchange in modern practice: when and when not to do it? EYE AND VISION 2014; 1:10. [PMID: 26605356 PMCID: PMC4655463 DOI: 10.1186/s40662-014-0010-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 11/05/2014] [Indexed: 11/10/2022]
Abstract
Cataract surgery due to advances in small incision surgery evolved from a procedure concerned with the primary focus on the safe removal of cataractous lens to a procedure focused on the best possible postoperative refractive result. As the outcomes of cataract surgery became better, the use of lens surgery as a refractive modality in patients without cataracts has increased in interest and in popularity. Removal of the crystalline lens for refractive purposes or refractive lens exchange (RLE) presents several advantages over corneal refractive surgery. Patients with high degrees of myopia, hyperopia and astigmatism are still not good candidates for laser surgery. Moreover, presbyopia can currently only be corrected with monovision or reading spectacles. RLE supplemented with multifocal or accommodating intraocular lenses (IOLs) in combination with corneal astigmatic procedures might address all refractive errors including presbyopia, and eliminate the future need for cataract surgery.
Collapse
Affiliation(s)
- Jorge L Alió
- Vissum Corporation, Alicante, Spain ; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain ; Avda de Denia s/n, Edificio Vissum, 03016 Alicante, Spain
| | - Andrzej Grzybowski
- Department of Ophthalmology, Poznan City Hospital, Poznań, Poland ; Chair of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
| | - Dorota Romaniuk
- Clinical Department of Ophthalmology, Silesian University of Medicine, Katowice, Poland
| |
Collapse
|
8
|
Alio JL, Grzybowski A, El Aswad A, Romaniuk D. Refractive lens exchange. Surv Ophthalmol 2014; 59:579-98. [DOI: 10.1016/j.survophthal.2014.04.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 04/16/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
|
9
|
Akal A, Goncu T, Cakmak SS, Yuvaci I, Atas M, Demircan S, Yilmaz OF. Evaluation of early results of quick-chop phacoemulsification in the patients with high myopic cataract. Int J Ophthalmol 2014; 7:828-31. [PMID: 25349801 DOI: 10.3980/j.issn.2222-3959.2014.05.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 11/25/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To assess the early surgical outcomes of quick-chop phacoemulsification technique in patients with high myopia. METHODS The data of patients with high myopia who underwent quick-chop phacoemulsification were reviewed retrospectively. There were 42 eyes of 31 patients. The axial length was more than 26 mm in all eyes. All eyes underwent quick-chop phacoemulsification surgery with the placement of an intraocular lens (IOL) in the capsular bag. Postoperative visits were performed at 1, 3d; 2wk, 1mo. Early postoperative best corrected visual acuity (BCVA), preoperative and postoperative corneal endothelial cell density (ECD), central corneal thickness (CCT) and postoperative complications were assessed. Paired sample t-test or Wilcoxon tests were used to compare data between preoperative and postoperative data. RESULTS There was no statistically significant difference between preoperative and postoperative ECD and CCT. Retinal detachment was developed in one eye at postoperative first day. There was an iris prolapsus from side port insicion. CONCLUSION Quick-chop phacoemulsification technique is a safe surgical technique. However we can encounter some complications in high myopic eyes due to histopathological differences. Both side port and clear corneal tunnel insicion size is crucial for preventing postoperative complications. If any persistent leakage is noticed, suture should be placed.
Collapse
Affiliation(s)
- Ali Akal
- Department of Ophthalmology, School of Medicine, Harran University, Sanliurfa 63300, Turkey
| | - Tugba Goncu
- Department of Ophthalmology, School of Medicine, Harran University, Sanliurfa 63300, Turkey
| | - Sevin Soker Cakmak
- Department of Ophthalmology, School of Medicine, Harran University, Sanliurfa 63300, Turkey
| | - Isa Yuvaci
- Department of Ophthalmology, Kayseri Training and Research Hospital, Kayseri 38000, Turkey
| | - Mustafa Atas
- Department of Ophthalmology, Kayseri Training and Research Hospital, Kayseri 38000, Turkey
| | - Süleyman Demircan
- Department of Ophthalmology, Kayseri Training and Research Hospital, Kayseri 38000, Turkey
| | - Omer Faruk Yilmaz
- Department of Ophthalmology, School of Medicine, Harran University, Sanliurfa 63300, Turkey
| |
Collapse
|
10
|
Jeon S, Kim HS. Clinical characteristics and outcomes of cataract surgery in highly myopic Koreans. KOREAN JOURNAL OF OPHTHALMOLOGY 2011; 25:84-9. [PMID: 21461219 PMCID: PMC3060398 DOI: 10.3341/kjo.2011.25.2.84] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 08/01/2010] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the clinical characteristics and outcomes of cataract surgery in highly myopic Korean subjects. Methods We retrospectively reviewed the medical records of 694 eyes of 694 patients who underwent cataract surgery. The case group included 347 eyes of 347 patients whose axial lengths (AXL) were ≥26.00 mm, and the control group included 347 eyes of 347 patients with AXL between 22.00 and 25.99 mm. Cataract density was determined preoperatively using the Pentacam Scheimpflug imaging system. We compared age at operation, cataract type, coexisting disease, visual prognosis, and complications. Results The mean age at the time of the operation was 59.60 ± 12.28 years in the case group and 67.47 ± 11.36 years in the control group. The case group had a larger proportion of nuclear cataracts and posterior subcapsular cataracts (PSC), 40.63% and 26.22%, respectively, versus 25.07% and 11.82%, respectively, in the control group. Postoperative corrected visual acuity showed a negative correlation with AXL (R2 = 0.172), and severe funduscopic findings were related to poor visual prognosis (p = 0.05). The incidence of retinal detachment in the case group after cataract surgery was 1.72%, compared with 0.28% in the control group. Conclusions Highly myopic eyes tend to develop cataracts earlier than normal eyes and to have a higher prevalence of coexisting disease and complications, such as retinal detachment. Nuclear cataracts and PSC were more common in the highly myopic group. Poor visual prognosis was associated with longer axial length and retinal myopic degeneration.
Collapse
Affiliation(s)
- Sohee Jeon
- Department of Ophthalmology, St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea
| | | |
Collapse
|
11
|
Wang Y, Nie L. Use of the anterior chamber maintainer in trabeculectomy following vitrectomy. Curr Eye Res 2011; 36:232-7. [PMID: 21275521 DOI: 10.3109/02713683.2010.543498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To retrospectively observe the effects of anterior chamber maintainer (ACM) placement in glaucoma patients undergoing trabeculectomy following vitrectomy. METHODS Trabeculectomy was performed on 51 secondary glaucoma patients (51 eyes), all of whom had undergone vitrectomy. During trabeculectomy, an ACM was placed in 27 eyes (group A), but not in the remaining 24 (group B). Intra- and post-operative complications were recorded. Intraocular pressure (IOP) measurements were recorded pre-operatively and repeated post-operatively on follow up days 1, 3, and 7, and months 1, 3, 6, 12, 18, and 24. Surgical success rates were recorded. RESULTS Mean pre-operative IOPs of groups A and B were 32.74 ± 11.25 and 34.29 ± 9.68 mmHg, respectively. In group A, anterior chamber bleeding (two cases), and choroidal detachment and/or ciliary detachment (four cases) occurred. In group B, anterior chamber bleeding (five cases), and choroidal detachment and/or ciliary detachment (11 cases) occurred. There was a statistically significant difference between the two groups. There also was statistically significant difference in post-operative IOPs between the two groups at 12 and 24 months. The surgical success rate of group A was higher than that of group B. CONCLUSION ACM is effective in maintaining IOP and reducing complications during trabeculectomy following vitrectomy, thereby increasing surgical success rates.
Collapse
Affiliation(s)
- Yuhong Wang
- Department of Glaucoma, Eye Hospital of Wenzhou Medical College, Wenzhou, China.
| | | |
Collapse
|
12
|
Alio JL, Ruiz-Moreno JM, Shabayek MH, Lugo FL, Abd El Rahman AM. The risk of retinal detachment in high myopia after small incision coaxial phacoemulsification. Am J Ophthalmol 2007; 144:93-98. [PMID: 17509510 DOI: 10.1016/j.ajo.2007.03.043] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 03/21/2007] [Accepted: 03/23/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE Report incidence and risk of retinal detachment (RD)after coaxial phacoemulsification in high myopic patients. DESIGN Retrospective consecutive interventional study. METHODS SETTING Vissum-Instituto Oftalmologico de Alicante, Spain. PATIENT OR STUDY POPULATION: A total of 439 eyes from 274 high myopic patients with spherical equivalent (SE) >or= 6.00 diopters (D) or axial length >or= 26.00 mm. Mean age 62.2, axial length 27.88 +/- 2.11 mm (26.0 mm to 37.9 mm), SE -13.3 +/- 5.6 (-6.00 D to -46.0 D). MAIN OUTCOME MEASURES Incidence of RD, vitreous loss, and neodymium yttrium aluminum garnet (Nd:YAG) capsulotomy were evaluated after surgery at one, three, six, and 12 months then annually with mean follow-up 61.5 +/- 29.6 months. RESULTS Incidence of RD was 2.7% (12/439 eyes). In eyes with <or= 50 years of age was 3.65% (three eyes) compared with eyes with > 50 years of age was 2.52% (nine eyes). Cumulative risk of RD development by Kaplan-Meier analysis in all patients was 0.47%, 0.71%, 1.71%, 2.59%, and 3.28% at three, six, 15, 48, and 63 months until 105 months, respectively. In eyes <or= 50 years of age: the risk increases to 1.23% at three months and 4.46% at 63 months until 147 months, whereas eyes with > 50 years of age was 0.58% and 2.96% at six and 52 months until 118 months after cataract surgery, respectively. No significant correlation was found between the occurrence of RD and vitreous loss (P <or= .33) or Nd:YAG capsulotomy (P <or= .50 Chi-square test). CONCLUSIONS The incidence of RD in high myopic patients after coaxial phacoemulsification is 2.7%. A trend toward an increased incidence and risk in patients younger than 50 years of age was detected in this study.
Collapse
Affiliation(s)
- Jorge L Alio
- Vissum Instituto, Oftalmológico de Alicante, Alicante, Spain; Miguel Hernández University, Division of Ophthalmology, Medical School, Alicante, Spain
| | | | | | | | | |
Collapse
|