Modern Phacoemulsification and Intraocular Lens Implantation (Refractive Lens Exchange) Is Safe and Effective in Treating High Myopia

Abstract

Improved efficacy, predictability, and safety of modern phacoemulsification have resulted in cataract surgery being considered as a refractive procedure. Refractive lens exchange by definition is a surgery aimed at replacing the cataractous or clear crystalline lens with an intraocular lens (IOL) in cases of high ametropia. The excellent intraocular optics of this procedure provide a better visual outcome as compared with laser refractive surgery in high myopia. With advances in technology and IOL formulas, the predictability of refractive outcome after cataract surgery in high myopes has improved. The option of addressing presbyopia using multifocal/accommodating IOLs or monovision results in patients achieving reasonable spectacle independence. The most important concern with respect to phacoemulsification in high myopia is the risk of pseudophakic retinal detachment. High myopia is an independent risk factor for retinal detachment, and recent publications have reported a much lesser risk of retinal detachment specifically attributable to phacoemulsification in high myopes, especially if a thorough posterior segment evaluation is done and patients are followed up until development of complete posterior vitreous detachment. Refractive lens exchange is an effective and safe option to correct high myopia and can significantly improve quality of life in select patients.