Retinal detachment after clear lens extraction for high myopia: Seven-year follow-up

Abstract

Objective To prospectively evaluate the incidence of complications, particularly retinal detachment, 7 years after clear lens extraction (CLE) for myopia greater than −12 diopters (D). Design Extended follow-up of noncomparative case series. Participants Fifty-two eyes of 30 patients with preoperative myopia greater than −12 D, best-corrected visual acuity (BCVA) of 20/100 or better, and intolerance of contact lenses. Intervention Patients with lattice degeneration, retinal tear, or hole underwent photocoagulation before CLE. The authors performed phacoemulsification through a 3.2-mm-wide incision using primary irrigation and aspiration, widened the incision to 6.5 mm, and implanted a one-piece polymethyl methacrylate intraocular lens (IOL). Main outcome measures The BCVA, uncorrected visual acuity (UCVA), stability of spherical equivalent (SE), neodymium:YAG (Nd:YAG) capsulotomy rate, and complications (especially retinal detachment). Results At 7 years, the SEs of 29 eyes (59.1%) were within ±1.0 D of emmetropia and 42 eyes (85.7%) were within ±2.0 D. Mean SE was −1.01 D (±0.94). At 7 years, mean UCVA was 20/80 compared with 20/66 at 1 year. BCVA and UCVA were better in eyes with open capsules versus intact capsules. During the 7 years, 30 eyes (61.2%) required capsulotomy for opacification. Mean time for capsulotomy was 48.4 months after CLE. The authors performed ten argon laser retinal treatments after surgery, with all but one in the first postoperative year. The overall incidence of posterior vitreous detachment was 16.3%. The incidence of retinal detachment during the 7 years was 4 of 49 eyes, or 8.1% (vs. 2.0% at 4 years). One patient had bilateral retinal detachments. Conclusion Despite advances in surgical technique, retinal detachment remains a major concern after CLE for high myopia. In the authors’ series, the incidence of retinal detachment after CLE was nearly double that estimated for persons with myopia greater than −10 D who do not undergo surgery. Although CLE has advantages, including rapid and predictable visual rehabilitation, stable refraction, the ability to replace the IOL, and often superb optical quality with no irregular astigmatism, it is invasive and can result in severe vision loss. Long and continuous follow-up of the outcomes of CLE for high myopia is absolutely necessary before the authors can consider CLE as a routine option for patients with high myopia.