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The patients included in the study ranged in age from 32 to 49 years. ICL implantation was performed in 41 eyes of 21 patients (mean age, 35.7 years) while 18 patients (mean age, 44.6 years) underwent bilateral CLE with IOL implantation. All patients had a complete preoperative ophthalmological exam. Phakic lens implantation was performed as the preferred procedure in patients requiring an add of one dioptre or less to read J2 and demonstrating recent stable distance vision. Patients who did not fulfill those criteria as well as those with an anterior chamber depth of less than 2.8 mm or found to have initial opacification of the crystalline lens at the slit-lamp underwent CLE. Argon laser photocoagulation was performed in any eye found to have lattice degeneration, focal snail track degeneration, or a retinal tear or hole. The patients' preoperative spherical equivalent (SE) ranged from -6.0 to -28.0 D. Mean SE was -13.6 D for the ICL group and -16.7 D for the CLE group. Follow-up reached at least 31 months for all eyes and exceeded four years for about half of the ICL group and nearly two-thirds of the CLE group. At one year, refractive and functional results were favorable in both groups. All ICL recipients were targeted for emmetropia and achieved a mean SE of -1.06 D, with 71% within one dioptre of target and 83% within two dioptres. Mean post-op SE in the CLE group was -1.88 D. Just under half of the eyes (47%) had achieved an SE within one dioptre of intended refraction, while 80.5% were two dioptres. There were no losses of BCVA at one year. More than three-fourths of eyes in each group showed gains in BCVA post-operatively. Before surgery, BCVA was better than 20/40 in 76% of ICL eyes and 58% of those that underwent CLE. At one year post-op, BCVA was 20/40 or better in 88% of ICL eyes and 81% of those that had CLE. Subjective satisfaction was also high in both treatment groups. However, 17% of ICL recipients complained of halos and nearly 20% of those who underwent CLE were disturbed by needing spectacles for near vision tasks, Dr. ArnŽ reported. The profile of later complications, however, differed between the two groups. Among ICL recipients, the only complication encountered that required surgical intervention was opacification of the crystalline lens. The complication occurred in three (7.3%) eyes after a follow-up of at least two years and necessitated ICL removal, phacoemulsification and implantation of a standard posterior chamber IOL. At six months after that procedure, BCVA was 20/25 in two eyes, 20/32 in the third, and overall equal to or better than that measured at one year after the ICL implantation."The incidence of cataract development after implantation of a phakic posterior chamber IOL is higher in this study relative to previous reports, although that may reflect the fact that the mean age of patients in our series is older than in other studies. We can, therefore, postulate that implantation of a phakic posterior lens in highly myopic eyes of patients aged in their 40s or 50s may increase the trend to develop cataract," Dr. ArnŽ said. mong patients who underwent CLE, 42% developed PCO requiring a YAG capsulotomy between one and four years after implantation. Retinal detachment occurred in two eyes at 39 months and 43 months, respectively, after CLE and both eyes had a poor visual outcome (²20/200), as one had vitreous retraction with a persistent retinal detachment and the other developed chronic macular oedema despite successful reattachment surgery. "This experience is consistent with previous studies showing there is a high incidence of PCO after lens extraction in highly myopic eyes of patients younger than age 50 as well as an elevated risk for retinal detachment. As reported by Joseph Colin MD and colleagues, the incidence of retinal detachment is increased nearly twofold in eyes with myopia of 12 D or greater that undergo CLE relative to unoperated eyes," Dr. ArnŽ said.
ean L. ArnŽ MD
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