Myopes are more likely to develop vitreoretinal complications than hyperopes after lens exchange

Dermot McGrath in Rome

Bimanual cortical aspiration	New IOL generations are increasing the safety and effectiveness of phacorefractive surgery.
New technologies like MICS are increasing the safety and effectiveness of phacorefractive surgery	Right hand aspiration

MYOPIC patients run a higher risk of developing vitreoretinal complications than hyperopes undergoing clear lens exchange, according to Arturo Pérez-Arteaga MD.

Viscoelastic injection before IOL insertion. Notice the high myopic eye.

He outlined the findings of six-year retrospective study of 1,850 patients who underwent clear lens refractive exchange in a presentation at the 7th ESCRS Winter Refractive Surgery Meeting.

Some 70% of the patents were myopic cases and remainder hyperopic.
"We did a retrospective review of the files and searched for any kind of vitreo-retinal disease reported and in these cases we also looked for any surgical complication and the refractive outcome of these patients. Only patients with a complete file were included," he explained.

He reported a statistically significant difference between the incidence of vitreoretinal complications for the myopic and hyperopic groups. Some 18 cases of retinal detachment occurred among myopic patients - an incidence of 1.39%. In contrast, only one hyperopic patient developed a retinal detachment after surgery - an incidence of 0.2%.

The myopic patients, who ranged in age from 29 to 60 years, developed the retinal detachments from one day to 32 months postoperatively. Two thirds of patients with complications had posterior YAG laser capsulotomy. Half the patients showed a loss of preoperative BCVA and two of them developed severe vitreo-retinal diseases, both with posterior capsule rupture during phaco.

The hyperopic patient was a 60-year old man who developed retinal complications 18 months after surgery. In this case, the posterior capsule was broken during the phaco-refractive surgery. However, that patient recorded a postoperative BCVA of 20/30 - the same as his preoperative corrected visual acuity.

"There is more evidence of vitreo-retinal complications in patients with myopia, compared to patients with hyperopia after the clear lens exchange. We also found that the incidence of complications increased when the surgery was complicated and that posterior capsule rupture during or after the surgery increases the incidence of complications and decreases the prognosis of visual recovery in these patients," Dr Pérez-Arteaga reported.

Myopic patients were also more likely to develop macular diseases related to surgery. Some 3.63% of patients in the myopic group developed macular problems postoperatively, compared with only 1.43% of the hyperopic patients. Dr Pérez-Arteaga noted that some of the patients developed macular disease over time, but it was not related to the original surgery.

The retrospective review also revealed two cases of endophthalmitis, one in each treatment group. Dr Pérez-Arteaga commented that his clinical experiences had prompted him to adopt different measures for reducing the likelihood of complications resulting from phaco-refractive surgery in myopic patients.

"What I learned after all these years is that patient selection is absolutely vital for good results with clear lens exchange. Not every refractive error is a good candidate for this type of treatment. I have increased the average patient age for this procedure, as it seems to give better long-term results with slightly older patients," he said.
Dr Pérez-Arteaga added that it was important to minimise trauma during surgery with minimal invasive techniques.

"In certain cases in which the nucleus is soft, I don’t use ultrasound aspiration during phaco. I naturally try to avoid causing any damage to the integrity of the posterior capsule and I always work with vitreo-retinal specialists on these types of patients," he said.
The fact that there have been significant advances in phaco equipment in recent years has also improved the refractive results, Dr Pérez-Arteaga said. He advised that the surgeon should never lose sight of the real objectives of the treatment.

"I think we must bear in mind that emmetropia is not necessarily the target result in 100% of cases, especially in young patients. Sometimes the target in those patients may be a lower amount of myopia and this procedure can give them satisfactory results if the factors mentioned are taken into account."

Arturo Pérez-Arteaga MD
Tlalnepantla, Estado de México, Mexico
Email: drarturo@prodigy.net.mx

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