A CASE OF OPERATIVE DAY WITH AXIAL EYE LENGTH DIFFERENCE MORE THAN 19MM.

To assess peculiarities of phacoemulsification with IOL implantation in patients with highly severe ametropia, including preparation for the surgery, implementation of the procedure, and further rehabilitation

To assess peculiarities of phacoemulsification with IOL implantation in patients with highly severe ametropia, including preparation for the surgery, implementation of the procedure, and further rehabilitation. 

In one surgical day two patients were operated: patient 65 years old with high myopia and axial length 35,11mm. The second patient, 62 years old with high hyperopia, amblyopia, and axial eye length 15,41mm.   IOL were calculated for both patients: -6,00D and + 42,00 D.  The difference in axial length was 19,7mm, and IOL power difference was 48D. Examination revealed differences in the eye anatomy and presence of concurrent pathology, so IOL calculations were performed individually: in myopia IOL was calculated using Kane formula, in hyperopia - Hoffer Q. Phacoemulsification was performed, IOLs  -6,00 D and +42,00 D were implanted.

Both patients’ BCVA was 0,1. Cylindrical component was not corrected as there were no suitable IOLs. Differences between eyes included: anterior eye chamber structure, intraocular pressure, condition of the vitreous body, macula, optic disc, trabecular pigmentation, individual anesthesia method for patient with high myopia, the target pressure parameter on Centurion was changed. The lens density was equivalent, ultrasound parameters were approximate. Postoperative period was different in hydrodynamics and in macula reaction to operative trauma. 

The outcomes can be successful employing individual and clinically different approach to concurrent pathology diagnostics, individual calculations, anesthesia, intraoperative target pressure and postoperative complications prophylaxis.