Phakic IOL implantation versus clear lens extraction in highly myopic eyes

Abstract

We appreciate Arne's idea of comparing phakic intraocular lens (IOL) implantation and clear lens extraction (CLE) in highly myopic eyes.1 However, we would like to comment on a few aspects of the study. The results would have been more conclusive if the inclusion criteria had been the same in both groups. There are 2 separate groups in the study. The phakic IOL group had a mean age of 35.7 years (range 32 to 43 years), whereas the CLE group had a mean age of 44.6 years (range 36 to 49 years). Also, the mean preoperative spherical equivalent refractive error was −13.6 ± 3.0 diopters (D) in the phakic IOL group and −16.7 ± 3.8 D in the CLE group. We think these are distinct groups and cannot be compared with each other. We also think that all the patients should be unilaterally or bilaterally recruited to increase the strength of the study. We would also like to clarify that the implantable contact lens from Staar is hydrophilic acrylic and not hydrophobic acrylic. In the CLE group, a retinal detachment occurred in 2 cases. Both were implanted with a poly(methyl methacrylate) IOL, and a neodymium:YAG (Nd:YAG) capsulotomy was performed to treat posterior capsule opacification. Using modern foldable IOLs with sharp edges results in a lower incidence of PCO and complications following Nd:YAG capsulotomy.1–4 We think it would have been more appropriate if the same foldable IOL had been implanted in all CLE cases. Also, the patients in the CLE group were older and more myopic. Both these preexisting factors are known to predispose to retinal detachment.3,5 Finally, although the author explained the postsurgical satisfaction, the reference on the description of the satisfaction scale is missing. A prospective randomized trial comparing these 2 methods would be more conclusive and desirable. Mayank A. Nanavaty DO Abhay R. Vasavada MS, FRCS Charlotta Zetterström MD, PhD aAhmedabad, India bStockholm, Sweden