Intraocular lens changes after short- and long-term exposure to intraocular silicone oil. An in vivo study

Alternative Techniques To Remove Retained Silicone Oil Droplets On IOLs

BACKGROUND/PURPOSE

To describe several modified approaches to remove retained silicone oil droplets on intraocular lens (IOLs).

METHODS

Four novel techniques for removing retained silicone oil droplets on IOLs were described.

RESULTS

All four techniques led to an improved IOL with a good view to the posterior segment. No intraoperative or long-term postoperative complications have been seen in any of these eyes. These modified approaches are safe, efficient, low cost, and use existing vitreoretinal operating room supplies to add to the vitreoretinal surgeon's armamentarium to clear retained IOL silicone droplets.

CONCLUSION

It is advocated for having multiple techniques at the disposal of the vitreoretinal surgeon to address retained silicone oil on IOLs. Being able to use multiple techniques may not be superior than a single approach but is often necessary to accomplish the surgical goal of removing these adherent droplets.

The use of polyisobutylene-based polymers in ophthalmology

A novel polyolefin called poly(styrene-block-isobutylene-block-styrene) (“SIBS”) originated from Joseph P. Kennedy's laboratory at the University of Akron (Akron, Ohio, United States) and was developed as a biomaterial for long-term implant applications by the author. SIBS has no cleavable groups on its backbone or sidechains, is comprised predominantly of alternating secondary and quaternary carbons on its backbone, which prevents embrittlement and cracking under flexion, and undergoes multiple purification steps which renders it extremely biocompatible and well-suited for long-term applications in the eye. This article explores two ophthalmic devices; 1) the PRESERFLO® MicroShunt (Santen Pharmaceutical Co. Ltd., Osaka, Japan) made from SIBS that lowers intraocular pressure to thwart progression of vision loss from glaucoma, and 2) a novel intraocular lens (IOL) made from crosslinked polyisobutylene, which is under-development by Xi'an Eyedeal Medical Technology Co., Ltd. (Xi'an, China) that does not glisten nor cloud over time, as do most conventional IOLs.

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A novel class of ultra-biostable polyisobutylene-based biomaterials for long-term implant applications.

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A novel class of polyisobutylene-based biomaterials that is not bioactive and elicits minimal foreign body reaction.

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A device called the PRESERFLO® MicroShunt to treat glaucoma made from poly(styrene-block-isobutylene-block-styrene) (SIBS).

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A novel crosslinked polyisobutylene material for intraocular lens applications that eliminates glistenings and halos.

Advances in the Study of Lens Refilling

The ultimate goal of cataract surgery is to restore the accommodation while restoring distance visual acuity. Different kinds of accommodative intraocular lens (IOLs) and surgical techniques have been suggested to apply during the surgery, but they showed poor postoperative accommodation. It is possible to achieve this goal by refilling the lens with an injectable polymer. We present a summary of the existing materials, methods, results, and some obstacles in clinical application that remain of lens refilling for restoration of accommodation. Two main problems have restricted the clinical application of this technique. One was the formation of postoperative secondary capsule opacification and the other was the different accommodative power after surgery.

Improvement of Uveal and Capsular Biocompatibility of Hydrophobic Acrylic Intraocular Lens by Surface Grafting with 2-Methacryloyloxyethyl Phosphorylcholine-Methacrylic Acid Copolymer

Biocompatibility of intraocular lens (IOL) is critical to vision reconstruction after cataract surgery. Foldable hydrophobic acrylic IOL is vulnerable to the adhesion of extracellular matrix proteins and cells, leading to increased incidence of postoperative inflammation and capsule opacification. To increase IOL biocompatibility, we synthesized a hydrophilic copolymer P(MPC-MAA) and grafted the copolymer onto the surface of IOL through air plasma treatment. X-ray photoelectron spectroscopy, atomic force microscopy and static water contact angle were used to characterize chemical changes, topography and hydrophilicity of the IOL surface, respectively. Quartz crystal microbalance with dissipation (QCM-D) showed that P(MPC-MAA) modified IOLs were resistant to protein adsorption. Moreover, P(MPC-MAA) modification inhibited adhesion and proliferation of lens epithelial cells (LECs) in vitro. To analyze uveal and capsular biocompatibility in vivo, we implanted the P(MPC-MAA) modified IOLs into rabbits after phacoemulsification. P(MPC-MAA) modification significantly reduced postoperative inflammation and anterior capsule opacification (ACO), and did not affect posterior capsule opacification (PCO). Collectively, our study suggests that surface modification by P(MPC-MAA) can significantly improve uveal and capsular biocompatibility of hydrophobic acrylic IOL, which could potentially benefit patients with blood-aqueous barrier damage.

Retention of silicone oil droplets from ophthalmic viscosurgical devices in the drainage angle of 2 eyes

We report the outcome in 2 eyes of 2 patients with retained silicone oil droplets in the anterior chamber drainage angle after the use of an ophthalmic viscosurgical device (OVD) during cataract surgery. Silicone oil droplets were observed when the OVD was injected into the anterior chamber during phacoemulsification. Despite removal by irrigation and aspiration, droplets were observed in the anterior chamber during the immediate postoperative period. At 15 months, they were observed in the drainage angle. The retained silicone did not produce untoward side effects in the eyes. Silicone oil is a common contaminant in OVDs but appears to be inert and harmless when retained in small amounts in the anterior chamber drainage angle.

Optical Quality Measurements of Hydrophobic Acrylic Intraocular Lenses

PURPOSE

To compare the optical quality of several models of hydrophobic acrylic intraocular lenses (IOLs).

METHODS

Modulation transfer function (MTF) measurements were performed using a model eye system on four models of hydrophobic acrylic IOLs. Models tested were the AcrySof SA60AT, MA60AC, and MA60BM (Alcon, Ft Worth, Tex), as well as the model VA-60BB (Hoya, Tokyo, Japan). For benchmarking, the Alcon model MZ60BD polymethylmethacrylate (PMMA) lens was also measured. Three lenses of each model were tested at frequencies of 50 and 100 line pairs (lp)/mm (corresponding to 20/40 and 20/20, respectively).

RESULTS

With a 3-mm aperture, the Alcon AcrySof models had mean MTF values ranging from 58.5% to 60.3% at 100 lp/mm and 78.0% to 79.7% at 50 lp/mm. The Hoya model VA-60BB provided statistically significantly lower (P<.05) MTF values than the Alcon AcrySof models at both frequencies (47.3 +/- 1.2% at 100 lp/mm and 71.8 +/- 1.9% at 50 lp/mm). With a 5-mm aperture, the Alcon AcrySof models had MTF values ranging from 32.9% to 34.3% at 100 lp/mm and 45.2% to 46.7% at 50 lp/mm. Under these larger aperture conditions, the Hoya model VA-60BB also had statistically significantly lower MTF values (20.9 +/- 0.8% at 100 lp/mm and 27.2 +/- 1.1% at 50 lp/mm). Under both apertures and frequencies, the Alcon PMMA lens had statistically significantly higher MTF values than the Hoya lens and statistically significant lower MTF values than all AcrySof models.

CONCLUSIONS

Using both 3- and 5-mm aperture settings as well as frequencies corresponding to 20/20 and 20/40 vision, statistically significantly higher MTF values were obtained for AcrySof lenses, which were greater than the PMMA lens, which were greater than the Hoya model VA-60BB. The differences in MTF values between lens models are more exaggerated with a 5-mm aperture and may highlight differences in lens manufacturing processes.

Phacoemulsification and foldable intraocular lens implantation combined with vitrectomy and silicone oil tamponade for severe proliferative diabetic retinopathy

PURPOSE

To determine the clinical outcomes of phacoemulsification and foldable intraocular lens (IOL) implantation combined with primary vitrectomy and silicone oil tamponade to treat severe proliferative diabetic retinopathy (PDR).

SETTING

Department of Ophthalmology, Seoul National University College of Medicine, and Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea.

METHODS

The results of combined cataract surgery and silicone oil injection in 20 eyes (20 patients) were retrospectively analyzed. All patients had tractional or tractional-rhegmatogenous retinal detachment and clinically significant lens opacities; none had previous intraocular surgery. An acrylic foldable IOL was implanted in the capsular bag or ciliary sulcus.

RESULTS

Primary anatomic success was achieved in 90% of eyes. Functional success was attained in 60% of eyes after a mean follow-up of 7.6 months. The postoperative visual acuity improved in 60% of patients, was unchanged in 20%, and was worse in 20%. Silicone oil was removed in 80% of patients without complications after a mean of 3.4 months. The mean absolute value of the difference between the predicted refraction and postoperative refraction was 0.74 diopter (D) (range 0.03 to 1.74 D).

CONCLUSION

Phacoemulsification and foldable IOL implantation combined with primary vitrectomy and silicone oil tamponade was performed safely with favorable anatomic and visual outcomes in eyes with severe PDR.

Foldable versus rigid intraocular lenses in conjunction with pars plana vitrectomy and other vitreoretinal procedures

PURPOSE

To compare the results of foldable acrylic intraocular lens (IOL) implantation through a clear corneal incision with those of rigid IOL implantation in eyes having pars plana vitrectomy (PPV).

SETTING

Tertiary referral-based university institute.

METHODS

A consecutive retrospective comparative chart review was performed in all eyes that had PPV and foldable IOL implantation between May 15, 1999, and November 1, 2000 (n = 30), and all eyes that had PPV and rigid IOL implantation between April 1, 1996, and May 14, 1999 (n = 30). Preoperative baseline data and postoperative outcome data were recorded. Pars plana vitrectomy and associated vitreoretinal procedures were performed as indicated according to individual circumstances. A minimum of 1 week of follow-up information was available for all eyes.

RESULTS

Baseline characteristics in both groups of patients, including age, sex, eye involved, and phakic state, were similar. The preoperative visual acuities were also similar, ranging from 20/30 to hand motions; the mean visual acuity was 20/200. The IOL was implanted in all eyes uneventfully and did not restrict fundoscopy. The mean follow-up was significantly longer in the rigid IOL group (20 months) than in the foldable IOL group (7 months) (P<.001), probably because of the earlier case acquisition. The mean postoperative best corrected visual acuity was 20/200 in the foldable IOL group and 20/100 in the rigid IOL group. There was no difference between the 2 groups in the rate of postoperative retinal detachment, recurrent macular hole, or repeat PPV. Elevated intraocular pressure (IOP) on the first postoperative day was more common in the rigid IOL group than in the foldable IOL group (P =.078) because more patients in the rigid IOL group had surgery for diabetic ocular complications and these patients had a greater IOP rise.

CONCLUSION

Acrylic IOLs can be safely implanted in conjunction with PPV in selected cases.

Complete occlusion of the anterior capsular opening by fibrocellular membrane associated with retained silicone oil: a clinicopathologic correlation

BACKGROUND

To report the clinicopathologic features of a fibrocellular membrane in a pseudophakic eye with retained silicone oil in the absence of any capsular contraction syndrome, necessitating repeat anterior capsulorhexis.

METHODS

Clinicopathologic report of a case.

RESULTS

Histopathologic study of the membrane showed absence of any true periodic acid Schiff-positive capsule within the specimen. Clinically, there was no evidence of any anterior capsular contraction. The fibrocellular membrane may have occurred as a result of inflammatory and mechanical effects of silicone oil in the anterior chamber or as a result of the intraocular lens design.

CONCLUSION

The authors report the clinicopathologic features of a fibrocellular membrane occluding the anterior capsular opening in a pseudophakic eye with retained silicone oil, in the absence of any capsular contraction. The stimulus for its formation may have been the inflammatory and mechanical effects of retained silicone oil in the anterior chamber.

Relationship between posterior capsule opacification and intraocular lens biocompatibility

The type of healing process that occurs in response to cataract surgery and intraocular lens (IOL) implantation is dependent on a complex set of variables. Their interactions determine whether or not optical clarity is restored as a result of this procedure. In this process, wound healing entails cells undergoing either epithelial-mesenchymal transition, resulting in the generation of fibroblastic cells and accumulation of extracellular matrix, or lenticular structure formation. Such desperate cellular behaviors are regulated by the localized release of different cytokines, including transforming growth factor beta and fibroblast growth factors, which can result in post-operative capsular opacification. Other factors affecting the biological and mechanical outcome of IOL implantation are its composition, surface properties and shape.

Cataract surgery and transpupillary silicone oil removal through a single scleral tunnel incision under topical anesthesia; sutureless surgery

The author evaluated the results of combined cataract extraction and transpupillary silicone oil removal through a single scleral tunnel incision, in eyes that had undergone pars plana vitrectomy with silicone oil tamponade. Twenty-four of the 46 eyes were operated on under topical anesthesia with Blumenthal mode mini-nucleus manual extracapsular cataract extraction technique (mini-nuc ECCE), and silicone oil was removed passively through planned posterior capsulorhexis via the scleral tunnel, followed by endocapsular intraocular lens (IOL) implantation. The operation was completed without any suturing. The remaining 22 eyes were similarly operated on with the same cataract extraction technique, but in these cases silicone oil was classically aspirated actively through pars plana sclerotomies. Results were evaluated by visual acuity measurement, duration of operation, and complications. The transpupillary silicone oil removal group had significantly less vitreous hemorrhage (0- 31.8%) and posterior capsule opacification (0-36.4%). Also, the mean duration of the operation was significantly shorter in this group. There was no significant difference between the two groups with regard to postoperative recurrence of retinal detachment (12.5-18.1%) and visual acuity outcome. The combination of mini-nuc ECCE with transpupillary silicone oil removal compares favorably with the combination of silicone oil aspiration through pars plana sclerotomies. This combined technique allows the surgeon to perform the operation under topical anesthesia and no sutures are required. The intervention period is shorter and no posterior capsule opacification or vitreous hemorrhage develops.

Pseudophakic retinal detachment

Pseudophakic retinal detachment is a rare, but potentially serious, complication of cataract surgery. The incidence of pseudophakic retinal detachment following current surgical techniques of cataract extraction, including extracapsular cataract extraction by nuclear expression and phacoemulsification, is lower than that found after intracapsular cataract extraction. The risk of pseudophakic retinal detachment appears to be increased in myopic patients, in those patients in whom vitreous loss had occurred at the time of cataract surgery, and in patients undergoing Nd:YAG posterior capsulotomy. Most cases present to the clinician when the macula is already detached and the central vision is affected. When evaluating patients with pseudophakic retinal detachment, the fundal view is often impaired by anterior or posterior capsular opacification, reflections related to the intraocular lens, or poor mydriasis. Scleral buckling, pneumatic retinopexy, and primary pars plana vitrectomy, with or without combined scleral buckling, are the surgical techniques used to treat pseudophakic retinal detachment. Anatomical success rates are high after vitreo-retinal surgery for pseudophakic retinal detachment, although a smaller proportion of patients recover good vision following surgery.

Phacoemulsification with transpupillary silicone oil removal and lens implantation through a corneal incision using topical anesthesia

PURPOSE

To evaluate phacoemulsification combined with transpupillary silicone oil removal and foldable intraocular lens (IOL) implantation through a single corneal incision and planned posterior capsulorhexis after pars plana vitrectomy using topical anesthesia.

SETTING

Department of Ophthalmology, University of Bari, Bari, Italy.

METHODS

This noncomparative nonrandomized noncontrolled interventional case series comprised 34 consecutive patients (34 eyes). The mean age of the 25 men and 9 women was 54.4 years +/- 13.3 (SD). A mean of 8.2 +/- 9.4 months after silicone oil injection, patients had phacoemulsification with transpupillary silicone oil removal and foldable acrylic IOL implantation through a single corneal incision and a planned posterior capsulorhexis under topical anesthesia. Patients were operated on by the same surgeon. Visual acuity, the frequency of retinal redetachment, secondary cataract and vitreous hemorrhage formation, subjective pain and discomfort, the duration of surgery, and intraocular pressure (IOP) were noted. The mean follow-up was 9.4 +/- 5.1 months (range 4 to 21 months).

RESULTS

Vision improved or stabilized in 88.2% of eyes. Retinal redetachment occurred in 4 eyes (11.8%) and transient vitreous hemorrhage in 1 (2.9%). All patients reported minimal discomfort during the procedure. The mean duration of surgery was 17 +/- 4 minutes. There was no significant intraoperative or postoperative IOP variation.

CONCLUSIONS

Combined phacoemulsification, transpupillary silicone oil removal, and IOL implantation through a single corneal incision under topical anesthesia was safe and effective. In general, the visual outcomes were good with improvement in visual acuity.

Cataract surgery results after pars plana vitrectomy

Continuous refinements in vitreoretinal surgical techniques and an increasing number of posterior segment disorders are being successfully managed with pars plana vitrectomy (PPV). This has resulted in an increase in the number of vitrectomized eyes seen by cataract surgeons. Cataract surgery in previously vitrectomized eyes has been reported to be more challenging than in eyes without previous vitrectomy. Special considerations and precautions are often required before, during, and after the surgery to successfully address these challenges. Several studies have reported that phacoemulsification with intraocular lens implantation after PPV is a relatively safe procedure that can improve visual acuity and quality of life. The extent of visual improvement may be limited only by retinal comorbidity.

Interaction of intraocular lenses with various concentrations of silicone oil: an experimental study

The aim of this study was to evaluate the interaction between various widely used intraocular lenses (IOLs) and silicone oils of different viscosities. Four groups of IOLs, including monoblock foldable hydrophilic acrylic IOLs (Morcher, type 92s); monoblock hydrophobic acrylic IOLs (Acrysof-SA60AT, Alcon); single-piece rigid polymethylmethacrylate (PMMA) IOLs (Intraocular Optical International-IOI-65130) and a three-piece foldable silicone optic IOL (CeeOn Edge 911A, Pharmacia UpJohn) were analyzed in vitro to determine the percentage adherence 1,000-centistoke, 1,300-centistoke or 5,000-centistokes silicone oil on the IOL optic. For each IOL type, there was no statistically significant difference in the mean silicone oil coverage (MSC) of the IOL optics for the different viscosities of silicone oil. Silicone IOLs had the highest MSC percentage (79.9%) whereas hydrophilic acrylic IOLs were the least silicone-covered IOLs (7.8%) compared to the other IOL types tested in this study. It is not the concentration of silicone oil that affects silicone oil coverage. When performing small-incision cataract surgery in patients who may require silicone oil injection, foldable hydrophilic acrylic or hydrophobic acrylic lenses should be preferred over standard foldable silicone lenses.

Results of combined vitreoretinal surgery and phacoemulsification with intraocular lens implantation

PURPOSE

To assess the outcome and complications after combined pars plana vitrectomy and phacoemulsification with intraocular lens implantation in patients with concomitant cataract and vitreoretinal abnormalities.

METHODS

This retrospective study consisted of 113 eyes of 109 patients with various vitreoretinal abnormalities and visually significant cataract. Vitreoretinal surgery was combined with clear corneal phacoemulsification and intraocular mplantation.

RESULTS

The combined surgery resulted in minimal complications, and postoperative visual acuity was improved in 83 eyes (71.6%). Visual acuity was improved by two or more lines in 26 eyes (66.6%) with proliferative diabetic retinopathy, 22 eyes (73%) with proliferative vitreoretinopathy, eight eyes (30.7%) with macular abnormalities, four eyes (55.5%) with trauma and two eyes (40%) with retinal vein occlusion.

CONCLUSIONS

The combined vitreoretinal surgery and phacoemulsification with intraocular lens implantation was safe and effective in treating vitreoretinal abnormalities coexisting with cataract. Combined surgery is recommended for all patients having simultaneous vitreoretinal pathological changes and cataract. The addition of phacoemulsification does not prolong vitreoretinal operative time notably nor increase the risk of intraoperative and postoperative complications significantly

Phacoemulsification combined with silicone oil removal through a posterior capsulorhexis

PURPOSE

To evaluate the technique of silicone oil removal through a posterior capsulorhexis combined with phacoemulsification and intraocular lens (IOL) implantation.

SETTING

Dr. Rajendra Prasad Center for Ophthalmic Sciences, New Delhi, India.

METHODS

Fifteen eyes of 15 patients had phacoemulsification with removal of silicone oil, which had been used for intraocular tamponade after a previous pars plana vitrectomy. Eyes with a stable retina were included in the series. In all eyes, the silicone oil was removed through a planned posterior capsulorhexis after phacoemulsification. The parameters evaluated were the primary diagnosis, duration between silicone oil instillation and phacoemulsification, type of cataract, preoperative and postoperative best corrected visual acuities (BCVAs), and complications such as frequency of retinal redetachment and secondary cataract.

RESULTS

Vitreoretinal surgery with silicone oil instillation was performed for rhegmatogenous-tractional detachment resulting from Eales' disease in 6 eyes and from proliferative diabetic retinopathy in 2 eyes, for primary rhegmatogenous retinal detachment in 6 eyes, and for traumatic rhegmatogenous detachment in 1 eye. The mean duration between the silicone oil instillation and phacoemulsification was 7.5 months +/- 3.8 (SD). Fourteen eyes had posterior subcapsular cataract, and 10 had nuclear sclerosis. Preoperative BCVA was worse than 6/60 in all eyes. The BCVA was 6/60 or better in 9 eyes after a minimum follow-up of 6 months. Two eyes had choroidal detachment in the early postoperative period. No eye had vitreous hemorrhage, retinal redetachment, secondary cataract, clinically significant endothelial decompensation or macular edema, or a dislocated IOL.

CONCLUSION

The results indicate that silicone oil removal through a posterior capsulorhexis during phacoemulsification is a viable option and can be performed in selected cases of cataract with previous silicone oil instillation and a stable retina.

Silicone oil-intraocular lens interaction: which lens to use?

AIM

To determine a suitable intraocular lens for implantation in patients at high risk of lens exposure to silicone oil in their lifetime.

METHODS

PMMA, AcrySof, AR40, AQUA-Sense, and Raysoft lenses were examined. Each lens was immersed for 5 minute intervals in balanced salt solution (BSS), in stained silicone oil, and again in BSS before being photographed in air and in BSS. Percentage silicone oil coverage of the lens optic was determined.

RESULTS

The mean percentage coating (MPC) for the lens biomaterials ranged from 5.2% to 21.5%. The Raysoft lens had significantly less oil coverage when statistically compared with the other lens types (p < 0.001).

CONCLUSION

A Raysoft (Rayner) lens is a suitable lens for implantation in patients who are at risk of severe vitreoretinal disease.

Solvent for removing silicone oil from intraocular lenses: experimental study comparing various biomaterials

PURPOSE

To evaluate the effectiveness of a perfluorocarbon-perfluorohexyloctane (PFHO)-in removing silicone oil from different intraocular lenses (IOLs) and determine whether any removal technique enhances the removal of silicone oil.

METHODS

Six IOL materials were analyzed: standard poly(methyl methacrylate) (PMMA), heparin-surface-modified (HSM) PMMA, AcrySof, 2 polyHEMAs with different water contents, and a second-generation SLM-2 silicone. One or 2 microL of a highly viscous silicone oil (5700 cs) was applied to the center of each IOL optic. Perfluorohexyloctane (2 mL) was then used to remove the silicone oil by 1 of 3 techniques: immersion of the IOL in PFHO; irrigation of the silicone oil with a small, blunt cannula; mechanical wiping with a PFHO-saturated Merocel swab (used only when irrigation failed). Next, each IOL was examined by light and scanning electron microscopy. The expanse of silicone oil residue remaining on the IOLs was objectively quantified using an integrated computerized analysis system combined with energy-dispersive spectrometry.

RESULTS

After application of 1 microL silicone oil, immersion in PFHO did not remove silicone oil from any IOL material. Irrigation with PFHO removed the silicone oil from the HSM PMMA and polyHEMA IOLs, but oil remained on the other lens materials. Mechanical wiping was necessary to remove the oil from the PMMA, AcrySof, and silicone IOLs. Attempts to remove 2 microL of silicone oil produced similar results. Although mechanical wiping of the AcrySof IOL removed all silicone oil, a slight residue remained on the PMMA and silicone IOLs. The PFHO irrigation removed significantly more silicone oil from the HSM PMMA than the unmodified PMMA IOL (P =.001). More silicone oil was removed from polyHEMA IOLs than from the AcrySof or silicone IOLs (P =.05).

CONCLUSION

Although PFHO can remove silicone oil, it is of limited usefulness. The effectiveness of PFHO depends on the removal technique, IOL material, and amount of silicone oil present. Based on these results, we recommend PFHO irrigation followed by mechanical wiping with a PFHO-saturated swab.

Retinal detachment after clear lens extraction for high myopia: seven-year follow-up

OBJECTIVE

To prospectively evaluate the incidence of complications, particularly retinal detachment, 7 years after clear lens extraction (CLE) for myopia greater than -12 diopters (D).

DESIGN

Extended follow-up of noncomparative case series.

PARTICIPANTS

Fifty-two eyes of 30 patients with preoperative myopia greater than -12 D, best-corrected visual acuity (BCVA) of 20/100 or better, and intolerance of contact lenses.

INTERVENTION

Patients with lattice degeneration, retinal tear, or hole underwent photocoagulation before CLE. The authors performed phacoemulsification through a 3.2-mm-wide incision using primary irrigation and aspiration, widened the incision to 6.5 mm, and implanted a one-piece polymethyl methacrylate intraocular lens (IOL).

MAIN OUTCOME MEASURES

The BCVA, uncorrected visual acuity (UCVA), stability of spherical equivalent (SE), neodymium:YAG (Nd:YAG) capsulotomy rate, and complications (especially retinal detachment).

RESULTS

At 7 years, the SEs of 29 eyes (59.1%) were within +/-1.0 D of emmetropia and 42 eyes (85.7%) were within +/-2.0 D. Mean SE was -1.01 D (+/-0.94). At 7 years, mean UCVA was 20/80 compared with 20/66 at 1 year. BCVA and UCVA were better in eyes with open capsules versus intact capsules. During the 7 years, 30 eyes (61.2%) required capsulotomy for opacification. Mean time for capsulotomy was 48.4 months after CLE. The authors performed ten argon laser retinal treatments after surgery, with all but one in the first postoperative year. The overall incidence of posterior vitreous detachment was 16.3%. The incidence of retinal detachment during the 7 years was 4 of 49 eyes, or 8.1% (vs. 2.0% at 4 years). One patient had bilateral retinal detachments.

CONCLUSION

Despite advances in surgical technique, retinal detachment remains a major concern after CLE for high myopia. In the authors' series, the incidence of retinal detachment after CLE was nearly double that estimated for persons with myopia greater than -10 D who do not undergo surgery. Although CLE has advantages, including rapid and predictable visual rehabilitation, stable refraction, the ability to replace the IOL, and often superb optical quality with no irregular astigmatism, it is invasive and can result in severe vision loss. Long and continuous follow-up of the outcomes of CLE for high myopia is absolutely necessary before the authors can consider CLE as a routine option for patients with high myopia.