Results of phacoemulsification in high myopia

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Results of phacoemulsification in high myopia

  1. 1. Results of phacoemulsificationin 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.
  2. 2. 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 dislocationСcharacteristics 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
  3. 3. Purpose, Design and SettingPurpose: 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.
  4. 4. ParticipantsPatient demographics Patients (male/female) 33 (14/31) Eyes 45 Average age in yrs. (range) 71.0 + 5.4 (63 to 88)Inclusion criteria cases having axial length >25.0mm in one or both eyesExclusion criteria cases with previous refractive surgery
  5. 5. Methods and InterventionPreoperative Snellen’s visual acuity, slit-lamp examination, intraocularevaluation pressure (IOP) readings with Maklakov’s tonometryIOL powercalculation SRK/T formula, use of surgeon’s personalized A-constantComplicating hypermature cataract (7 eyes/15.5%), glaucoma (6/13.3),factors 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 visual acuity, postoperative spherical equivalent (SE),measures PCO, need for YAG laser capsulotomy, incidence of RDAvg. follow-up 10.4 months + 9.6 months (range 3 months to 4.3yrs)period
  6. 6. Results: visual acuity, SE Visual acuity SE 14 90 80Number of cases % 12 Number of cases 70 60 10 50 40 8 30 6 20 10 4 0 1st day 1 w eek 1 month 3 months 2 <0.1 0.1-0.25 0.3-0.5 >0.5 0 -7 -4 -3 -2 -1 0 1 2 5 Post operative follow up period Post operative refraction SE +/-1.0D. = 15 eyes (33.3%) SE +/-2.0D. = 32 eyes (71.1%)
  7. 7. Results:Intraoperative observations and complications S. No. Observations and complications Number % of eyes 1 Need for anterior capsule staining 37 82.2 (used trypan blue) 2 Pupil stretching 5 11.1 (used polymer iris hooks) 3 Pupil constriction during phacoemulsification 3 6.7 4 Posterior capsule rupture with vitreous loss 1 2.2 (iris-claw IOL fixed at the back of iris)
  8. 8. Results: Postoperative observations NumberS. No. Observations % of eyesEarly 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 2.2Late postoperative period 1 PCO reducing visual acuity 7 15.5 YAG laser capsulotomy done 2 5 11.1 (avg. period: 70 +/-23 weeks) 3 Retinal detachment 0 0
  9. 9. 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.
  10. 10. 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.

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