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Zero power intraocular lens implantation leading to emmetropic refraction after cataract surgery in a highly myopic female

Poster Details


First Author: S.Moutzouri GREECE

Co Author(s): E. Kanonidou                    

Abstract Details

Purpose:

Cataract surgery in patients with pathological myopia can be changeling for a variety of reasons. The precise calculation of the power of the intraocular lens (IOL) preoperatively is important to emmetropization postoperatively. Ultrasonic a-scan in long myopic eyes carries the risk of overestimation of the axial length (AXL), especially in the presence of posterior staphylomata, leading to postoperative hyperopia. The aim of this report is to examine the management of a highly myopic female with cataract formation and to assess the choice of the IOL power.

Setting:

Department of Ophthalmology, Hippokrateion General Hospital of Thessaloniki, Thessaloniki, Greece.

Methods:

68 year old female presented to the outpatients’ ophthalmological department with progressively deteriorating vision. Best Corrected Visual Acuity (BCVA) at presentation was 2/10 in right eye (OD) and counting fingers (CF) in left eye (OS). Her manifest refraction was (-16.00sph, -2,00cyl x45o) bilaterally. Her medical history consisted of dyslipidemia currently on Atorvastatin 10mg. Intraocular pressure was 12mmHg in both eyes. The slit lamp examination revealed dense nuclear cataract formation in both eyes (OS>OD). Dilated fundus examination showed myopic degeneration in both eyes. However, b-scan ultrasonography did not show a posterior pole staphyloma.

Results:

After thorough discussion with the patient the targeted refractive outcome postoperatively was unaided distant vision. A-scan measurement demonstrated an AXL of the left eye 31.72mm. The calculated power of the IOL ranged from -2.0 to +2.0 diopters (D) for a postoperative refraction of +1.87 to -2.13 D respectively. Uneventful phacoemulsification of the left eye was performed and a zero power monofocal foldable posterior chamber IOL was implanted to target emmetropic refraction. BCVA postoperatively was improved to 10/10 (OS) aided with 0.25sph. The patient was advised to undergo cataract surgery of the right eye in a short time.

Conclusions:

The implantation of a zero or low power posterior chamber IOL is preferable to aphakia after cataract surgery in patients with pathological myopia and cataract formation. The IOL acts as a barrier to vitreous movement and prevents subsequent retinal traction. The cataract surgery of the second eye in close temporal proximity is crucial in order to avoid aniseikonia due to significant anisometropia between the two eyes prior to the second cataract surgery.

Financial Disclosure:

None

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