Implants multifocaux chez le grand myope, résultats à 6 ans

Abstract

Currently, the use of multifocal IOL's remains controversial for patients with high myopia, especially because of the risk of retinal complications and poor quality of vision. Our goal was to evaluate this retinal risk and clarify the benefits obtained in this population in terms of visual acuity.Twenty-nine highly myopic patients (52 eyes with over 6 diopters of myopia) aged 40-69 years with early cataract by LOCSIII were selected for multifocal lens implantation, based on a healthy endothelium and retina as well as better visual acuity corrected to at least 0.5 - J2. Thirteen of them (21 eyes) had been previously implanted with a phakic IOL. The AT Lisa IOL (Zeiss©) was chosen because of the low powers available and ease of exchange. Data collection was conducted prospectively, at each visit. The main study parameters were the development of retinal complications, occurrence of PCO, patient satisfaction rate and rate of spectacle independence.At the end of the 6-year follow-up, we found 2 rhegmatogenous retinal detachments (3.8%) occurring at approximately 20 months and favorably treated without IOL explantation. We also found one case of macular atrophy secondary to cystoid edema. Twenty-seven uncomplicated YAG posterior capsulotomies were performed for posterior capsule opacification. Ninety-eight percent of patients reached best corrected visual acuity of at least 0.5 and 38% of at least 0.8 without correction. Finally, 85% of patients achieved spectacle independence, and all would be willing to undergo the same procedure.Multifocal IOL implantation in the high myope provided favorable results at 6 years, in carefully selected cases, providing optimal binocular visual comfort, including near vision. However, the fragility of the highly myopic retina mandates long-term follow-up. It would be beneficial to compare results of multifocal vs. monofocal IOL implantation in terms of visual performance and safety.