Outcomes of cataract surgery in eyes with axial length > 33 mm

Abstract

PurposeTo evaluate the visual outcomes and perioperative complications for cataract surgery in eyes with axial length (AL) > 33.0 mm. DesignProspective clinical cohort study. MethodsOne hundred and twenty-two eyes with moderate high myopia (26.0 mm ≤ AL<28.0 mm, control group), and 118 eyes with extreme high myopia (AL > 33.0 mm, EHM group) were followed up after cataract surgery (one week and one year post-op). Myopic maculopathy grading according to ATN system, best-corrected visual acuity (BCVA), and complications were compared. ResultsPostoperatively, BCVA in the EHM group improved significantly at both visits (both P < 0.001), despite being worse than that of the control group (both P < 0.05). The EHM group exhibited greater hyperopic refractive errors (P < 0.001), which were found to be associated with more severe T grade, longer AL, poorer second follow-up BCVA, and smaller anterior capsular opening (ACO) area. A higher incidence of retinal detachment and a more constricted ACO were observed in the EHM group (P = 0.030 and < 0.001, respectively), with the latter being significantly associated with longer AL and the absence of capsular tension ring (both P < 0.05). No difference in BCVA was found between the aphakic and pseudophakic eyes in the EHM group at both visits (both P > 0.05). ConclusionCataract surgery improves vision of eyes with AL > 33 mm, yet the increased risk of perioperative complications requires attention. Leaving these eyes aphakic might be effective and safe in the long term.