This document discusses considerations for phacoemulsification cataract surgery in myopic eyes. Key points addressed include: - Myopic eyes have a thinner sclera and weaker zonules, requiring special care during surgery like using clear corneal incisions and suturing if needed. - The anterior chamber is deeper in myopic eyes, making instrumentation more difficult and increasing risks like iris stretching and reverse pupillary block. - Careful preoperative evaluation of the fundus is important to assess for macular pathology, retinal breaks, or high myopia that could impact outcomes. - Intraocular lens power calculation and choice is more complex in myopic eyes to aim for residual myopia and account for axial length

1. PHACOEMULSIFICATION IN
MYOPIC EYES
Sumeet Agrawal
PG 3
UCMS and GTB Hospital
Delhi

2. HOW IS IT DIFFERENT FROM A
ROUTINE CATARACT SURGERY ?
PREOPERATIVE
INTRAOPERATIVE
POSTOPERATIVE

3. WHEN TO BE CONCERNED ?
• Degree of myopia
– High myopia (2%)
• ( Spherical equivalent -6.00 D or more; Axial length 26.5
mm or more)
– Pathological myopia (0.5%)
• ( Spherical equivalent -8.00 D or more; Axial length 32.5
or more)

4. UNILATERAL / BILATERAL
Keep the possibility of amblyopia, specially if unilateral
Visual acuity before onset of cataract
History of spectacle use; History of trauma
PATIENT EXPECTATIONS (informed consent)
Use of reading glasses
Refractive surprises
CENTRAL FUNDUS EVALUATION
*Macular scar* *Forster Fuch’s spot* *Myopic degeneration* *Epiretinal membrane*
*CNV* *Posterior staphyloma*
Careful INDIRECT OPHTHALMOSCOPY to look for retinal breaks
Zonular weakness
IOL POWER CALCULATION
*Axial length pitfalls* *SRK II / SRK-T / Holladay 2 formula*
*Aim for postop residual myopia*

6. INTRAOPERATIVE CONSIDERATIONS
• Peribulbar / Retrobulbar block : chances of globe
perforation ; topical / subtenon anaesthesia
• Clear corneal incisions with a short tunnel
– Limbal / scleral incisions heal poorly due to low scleral
rigidity
– Suture if in doubt
• High elasticity of anterior capsule

8. • Deep AC
– Difficult instrumentation
– Stretching of iris - > pain (intracameral lignocaine)
– Reverse pupillary block (Lens-Iris-Diaphragm
Retrodisplacement Syndrome (LIDRS))
– (Low bottle height with low vacuum)
• Avoid traction to vitreous base
– Abrupt collapse of anterior chamber
– Inject viscoelastic before removing probe

11. • Posterior capulorrhexis (to avoid future need for
YAG capsulotomy); controversial
• IOL
– To implant or not
– Abbott Medical Optics Sensar AR40M acrylic IOL (as
low as –10 D)
– Alcon AcrySof acrylic IOL (as low as –5 D)
– Bausch & Lomb Crystalens AO (as low as +4 D)
– Hoya Surgical Optics iSymm (as low as +6 D)
– Avoid silicon IOLs

12. POSTOPERATIVE
• Refraction takes longer to stabilize
• Check for retinal breaks
• Closer and more frequent follow ups
• Operate the other eye earlier if high
anisometropia

13. THANK YOU