Abstract
Cataract surgery due to advances in small incision surgery evolved from a procedure concerned with the primary focus on the safe removal of cataractous lens to a procedure focused on the best possible postoperative refractive result. As the outcomes of cataract surgery became better, the use of lens surgery as a refractive modality in patients without cataracts has increased in interest and in popularity. Removal of the crystalline lens for refractive purposes or refractive lens exchange (RLE) presents several advantages over corneal refractive surgery. Patients with high degrees of myopia, hyperopia and astigmatism are still not good candidates for laser surgery. Moreover, presbyopia can currently only be corrected with monovision or reading spectacles.RLE supplemented with multifocal or accommodating intraocular lenses (IOLs) in combination with corneal astigmatic procedures might address all refractive errors including presbyopia, and eliminate the future need for cataract surgery.
Highlights
Historical background of the clear lens extraction The concept of clear lens extraction dates back to the XVIIIth century, when Abbé Desmonceaux in 1776 was the first to perform such a surgery in France
First systematically conducted operations of clear lens exchange in high myopia in children and young adults were made by Polish ophthalmologist Vincenz Fukala in the last decades of the 19th century in Vienna
Changes detected in proteins of pseudophakic eyes coexist with alterations in structure of the vitreous body. They can contribute to the occurrence of retinal complications after lens surgery. It was argued [21] that in eyes with myopia greater than -8.0 D in pre-presbyopic patients who still accommodate, refractive lens exchange (RLE) should not be considered due to increased risk of retinal detachment (RD) (2.8-8.1%) and phakic lens implantation should be performed in such cases
Summary
Historical background of the clear lens extraction The concept of clear lens extraction dates back to the XVIIIth century, when Abbé Desmonceaux in 1776 was the first to perform such a surgery in France. They can contribute to the occurrence of retinal complications after lens surgery It was argued [21] that in eyes with myopia greater than -8.0 D in pre-presbyopic patients who still accommodate, RLE should not be considered due to increased risk of RD (2.8-8.1%) and phakic lens implantation should be performed in such cases. It was shown in a long-term follow-up study of RLE in high myopia [17], that myopic macular degeneration developed post-. RLE: Refractive lens extraction, SE: spherical equivalent, UDVA: uncorrected distance visual acuity, CDVA: corrected distance visual acuity, AL: axial length, IOL: intraocular lens, PRK: photorefractive keratectomy, LASIK: laser in situ keratomileusis, N/R: not reported. We may be able to obtain the highest benefits with the least possible risks [6,7]
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