Refractive Lens Exchange in High Myopia: Weighing the Risks

Abstract

lens correction is not limited to low and moderate myopes under the age of 40. The high myope with accommodative reserve may be a good candidate for phakic refractive lens implantation, and the presbyopic hyperope has become well recognized as a candidate for refractive lens exchange with an accommodating or multifocal intraocular lens (IOL) [1]. The myope over the age of 45, however, may be greeted with skepticism. Surgeons worry that presbyopic low myopes will not be satisfied with a simple trade of distance correction for near after bilateral laser-assisted insitu keratomileusis (LASIK) or a compromise of depth perception with monovision, while a multifocal or accommodating IOL may not offer the same quality of near vision they already have without correction. Refractive lens exchange for moderate to high myopes may raise concerns about significant complications, especially retinal detachment. In particular, eyes with long axial length and vitreoretinal changes consistent with axial myopia may be at higher risk for retinal detachment following lens extraction and IOL implantation. A review of the published literature is helpful in the evaluation of this risk. In an oft-cited study, Colin and colleagues have reported an incidence of retinal detachment of 8.1% after 7 years in high myopes (>12 D) undergoing refractive lens exchange [2]. Colin’s case series includes 49 eyes with a total of four retinal detachments. The first occurred in a male with an axial length of 30 mm and preoperative myopia of –20 D who required preoperative argon laser prophylaxis for peripheral retinal pathology and underwent refractive lens exchange at 30 years of age. His retinal detachment occurred 18 months after his lens surgery. The other three retinal detachments occurred following Refractive Lens Exchange in High Myopia: Weighing the Risks