Phacoemulsification of the crystallinelens with intracapsular implant for the correction of high myopia

Abstract

Introduction: Myopia is a social problem, with a major impact on patients’quality of life, especially at those with high myopia. There are several known methods for correction of high myopia: glasses, contact lenses, surgery to reduce the corneal refractive power with the help of laser, the removal of the transparent crystalline lens or with different degrees of opacity etc.Currently, the surgery ofthe removal of the lens, known since the late 19th century, becomes up-to-date again, dueto its performance at the microsurgical level, using modern apparatus and instruments, minimizing at maximum the appearance of the complications. Goal: The evaluation of short-term results of the refractive surgery by phacoemulsification and implantationin the capsular bag, of the artificial mono-, multifocal or toriclenses, to correct high myopia, that can’t be solved by other solutions. Objectives: - the study of the data of uncorrected and corrected visual acuity (VA) with glasses or contact lenses preoperative and postoperative; - evaluation of the keratometricdatapre- and postoperative;-the analysis of spherical and cylindrical refraction before surgery and after treatment; Material and methods: The study included 30 patients with high myopia (52 eyes), 4 men and 27 women, aged from 19-85 years: 19-39 years - 7 patients, 40-69 years - 16 patients, 70 - 85 years - 7 patients, operated at Ophthalmological Medical CenterOvisus, during the years 2009-2011, in whom the transparent lens has been removed or with different degrees of opacity, by phacoemulsification, making an incision of 2.2 mm, with intracapsular implantation of pseudofac: withAcrySof IQ - 26 patients (44 eyes), with AcrySof Restore - 2 patients (4 eyes), with AcrySofToric - 2 patients (4 eyes). The examination of the patients was performed preoperative and postoperative at least after 2 weeks, being evaluated the refractive status (spherical and cylindrical powers, spherical equivalent), keratometric values and VA. In all cases capsular tension ringswere used. Results: After surgical treatment, the VA of the patients improved in all cases - 100%. There were no significant intraoperative or postoperativecomplications. All patients postoperative, without correction, had won one or more lines of VA. In the group of patients with corneal astigmatism, residual astigmatism value was 90% less 2.0 diopters (D). 92% of patients required an optical distance correction (those operated with AcrySof IQ and Toric), with an average postoperative spherical equivalent of -2.0 D. 2 patients (4 eyes) didn’t require a distance or near correction (operated with AcrySof Restore). At 23% was revealeda postoperative refractive astigmatism, with a cylinder power between -0.5 and - 2 D. Conclusion: Minimally invasive surgical technique of lens extraction by phacoemulsification,using intraocular qualitative implants, placed in the capsular bag (AcrySof IQ, AcrySof Restore, AcrySof Toric) is the most effective way to get the best vision in patients with high myopia, with contraindications for other solutions of approaching the problem of functional vision reabilitation.