Visual And Refractive Outcomes After Clear Lens Extraction And Trifocal Intraocular Lens Implantation To Treat High Myopia In Patients Not Eligible For Corneal Laser Refractive Surgery Or Anterior Chamber Phakic Iol Implantation.

To assess visual and refractive outcomes after clear lens extraction (CLE) and trifocal intraocular lens (TIOL) implantation to treat high myopia in patients not eligible candidates for corneal laser refractive surgery or anterior chamber phakic intraocular lens implantation

National Ophthalmology Unit-Roosevelt Hospital, Guatemala City, Central America

Retrospective chart review of patients who underwent CLE and TIOL implantation to treat high myopia (axial length AL ≥26mm or myopia ≥-6D) and not eligible candidates for corneal laser refractive surgery (spheric equivalent SE ≥7D) or anterior chamber phakic IOL implantation (internal anterior chamber depth ACD <3mm) Corneal characteristics and ACD were measured using Pentacam®, ocular biometry using IOL Master 700® and IOL calculation adjusted with Panacea® IOL calculator. Pre/Post-operative uncorrected (UCVA), best corrected visual acuity (BCVA) and refraction were obtained at final consult. Postoperative complications were reported. Chi-square test and variance analysis were used with significance defined as p<0.05

Twenty-three eyes of thirteen patients were analyzed from Jul 2020 to Sept 2021 average follow-up was 12.3 mo. Mean age was 38.56 years (SD+/- 8.8) 78% were females. Mean preop SE was -11.4D, mean internal ACD was 2.78mm and mean AL 26.82mm. In 34.7% of eyes after CLE a toric TIOL was implanted. Final BCVA was better than preoperative BCVA in 18 eyes (78.2%), equal in 3 eyes (13%), and worse in 2 eyes (8.6%). Postoperative BCVA was 20/40 or better in 22 eyes (95.6%) vs.11 eyes (47.8%) before surgery (p<0.05). Mean postoperative SE was -1.47D (p<0.05). 2 patients needed neodymium:yttrium–aluminum–garnet (Nd:YAG) laser capsulotomy, no retinal complications were reported during the study period

In a Guatemalan reference center, patients undergoing implantation of TIOL after CLE to treat high myopia who are not eligible candidates for corneal refractive laser surgery (SE ≥7D) or anterior chamber phakic intraocular lenses implantation (ACD <3mm) have good visual and refractive outcomes with low rate of complications after the studied period. Implantation of trifocal lenses in young patients seems to be a safe procedure that brings an option to restore good visual acuity and near spectacles independence. To stablish safety and efficacy of the procedure more patient data and prospective clinical trials are needed along with long term follow-up