Results of phacoemulsification in high myopia

Kumar Vinod, Dushin Nicholai Vasilievich, Isufaj Edmond

Ophthalmic unit, Skhodnya city hospital, Moscow region Department of Ophthalmology, Russian people’s friendship

university, Moscow, Russia.

IntroductionCataract and myopia :

Early onset of cataract in myopic eyes Cataract in myopic eyes constitutes 5-20% of all cataract cases [Zuev A.V., 1995] Cataract and myopia co-exists in 7.2 to 55 % cases [Erichev VP et al.,2003]

Complicating factors: Peripheral and central choreoretinal dystrophies Liquefaction of vitreous body (VB) Posterior vitreous detachment (PVD) Weak Zinn’s ligaments unstable capsular bag lens dislocation

Сcharacteristics of cataract surgery in myopic eyes: Complication rates are higher by 1.5 to 2 times Anatomical changes after cataract surgery anterior movement of PC and

VB, volume increase of VB and increase in height of PVD high risk factors for retinal detachment (RD), cystoid macular edema and posterior capsule opacification (PCO) [Erie JC et al,2006; Tuft SJ et al.,2006; Ripandelli G. et al.,2007]

Small incision cataract surgery in myopic eyes: Closed chamber surgery+fluidics+use of viscoelastic material play key role

in preventing forward movement of the VB, reduce the incidence of PVD and RD [Ravalico G. et al.,2003; Gavris MC et al.,2004; Ji YH et al.,2005; Alio JL et al.,2007]

Early rehabilitation

Purpose, Design and Setting

Purpose: To investigate surgical outcome of phacoemulsification in high myopic eyes.

Design: Retrospective consecutive interventional study.

Setting: Ophthalmic unit, Skhodnya city hospital, Moscow region; Department of Ophthalmology, Russian people’s friendship university, Moscow, Russia.

Participants

Patient demographics

Patients (male/female) 33 (14/31)Eyes 45Average age in yrs. (range) 71.0 + 5.4 (63 to 88)

Inclusion criteria cases having axial length >25.0mm in one or both eyes

Exclusion criteria cases with previous refractive surgery

Methods and Intervention

Preoperative evaluation

Snellen’s visual acuity, slit-lamp examination, intraocular pressure (IOP) readings with Maklakov’s tonometry

IOL power calculation SRK/T formula, use of surgeon’s personalized A-constant

Complicating factors

hypermature cataract (7 eyes/15.5%), glaucoma (6/13.3), small rigid pupil (5/11.1), lens swelling (4/8.9), pseudo-exfoliation (4/8.9), weak Zinn’s ligaments (3/6.7)

Intervention Phacoemulsification through 2.8 mm clear corneal incision and implantation of an IOL (out of these combined glaucoma and cataract surgery – 2 eyes)

Outcome measures

visual acuity, postoperative spherical equivalent (SE), PCO, need for YAG laser capsulotomy, incidence of RD

Avg. follow-up period

10.4 months + 9.6 months (range 3 months to 4.3yrs)

Results: visual acuity, SE

0

10

20

30

40

50

60

70

80

90

1st day 1 w eek 1 month 3 months

<0.1 0.1-0.25 0.3-0.5 >0.5

0

2

4

6

8

10

12

14

-7 -4 -3 -2 -1 0 1 2 5

Visual acuity SE

Post operative refractionN

umb

er o

f ca

ses

Num

ber

of

case

s %

Post operative follow up period

SE +/-1.0D. = 15 eyes (33.3%)SE +/-2.0D. = 32 eyes (71.1%)

Results: Intraoperative observations and complications

S. No. Observations and complications Number of eyes

%

1 Need for anterior capsule staining

(used trypan blue)

37 82.2

2 Pupil stretching

(used polymer iris hooks)

5 11.1

3 Pupil constriction during phacoemulsification 3 6.7

4 Posterior capsule rupture with vitreous loss

(iris-claw IOL fixed at the back of iris)

1 2.2

Results: Postoperative observations

S. No. ObservationsNumber of eyes %

Early postoperative period

1 No complications observed 37 82.2

2 Descemetitis (striates, folds) 3 6.7

3 Exudative reaction in anterior chamber 2 4.4

4 High IOP 1 2.2

Late postoperative period

1 PCO reducing visual acuity 7 15.5

2YAG laser capsulotomy done

(avg. period: 70 +/-23 weeks)5 11.1

3 Retinal detachment 0 0

Conclusions

In patients with high myopia and cataract phacoemulsification with implantation of posterior chamber intraocular lens is a safe and effective surgical procedure which solves both visual problem and refractive deficiency.