Refractive lens exchange in a patient with high myopia and myopic astigmatism: a clinical case report

Abstract

Introduction. Refractive lens exchange is increasingly utilized for visual rehabilitation in patients with high myopia unsuitable for corneal refractive procedures. While effective, refractive lens exchange with intraocular lens implantation significantly improves visual acuity in young patients with high myopia and astigmatism, while maintaining a low risk of postoperative retinal complications, provided that thorough preoperative vitreoretinal assessment is conducted. However, it carries potential risks, notably retinal complications. Case presentation. We present a case involving a 45-year-old female with high axial myopia and myopic astigmatism who underwent bilateral refractive lens exchange with the implantation of monofocal intraocular lenses. Comprehensive preoperative assessments included optical biometry, tonometry, fundus examination, and visual acuity measurements. Postoperative recovery was uneventful in the right eye. However, the patient developed a retinal detachment in the left eye approximately one year post-surgery. This complication was successfully managed with pars plana vitrectomy, endolaser photocoagulation, and silicone oil tamponade, resulting in an improvement of visual acuity to 0.3. Conclusions. Refractive lens exchange can be an effective intervention for patients with high axial myopia but carries a risk of retinal detachment. Thorough preoperative evaluation, meticulous surgical technique, and patient counseling are essential. Prompt detection and management of complications like retinal detachment are crucial for preserving visual outcomes.