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Adjustable refractive surgery offers good results for high myopes

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Correcting high myopia through the use of adjustable refractive surgery (ARS), a technique that combines LASIK and the implantation of an intraocular lens, has provided good results in one study, according to a paper published in Ophthalmology, the clinical journal of the American Academy of Ophthalmology (AAO).

The noncomparitive interventional case series, conducted in Barcelona, Spain, treated 26 eyes in 18 patients. The patients had a range of myopia from –16 D to –23 D. Anything over –8 D is considered high myopia.

The ARS procedure involves two surgeries. The first surgery is creation of a corneal flap with as large an optical zone as possible. It is also at this time that an intraocular lens (IOL) is inserted through a posterior corneal incision. The second surgery, a LASIK enhancement that involves relifting the flap and correcting the residual refractive error, is performed 3 to 5 months later, once refraction and topography have stabilized.

The authors explain that the rationale for creating the corneal flap first during the intraocular surgery was "to avoid the possibility of contact between the IOL and the [endothelium] during the suction and cut in the LASIK procedure."

Twenty-eight months after both surgeries, 80.7% of the eyes were within 0.5 D and 100% were within 1 D of intended correction. Twenty-six percent of the eyes gained three or more lines of best-corrected visual acuity, and 42% gained two or more lines. There was no visual loss in any eye, and no serious complications were observed. Also, there were no statistically significant differences between preoperative and postoperative contrast sensitivity up to 2 years after the surgeries. Two patients had some subjective disturbances at night.

In a commentary on the paper, AAO spokesperson Ernest W. Kornmehl, MD, said, "Although there is controversy surrounding the implantation of intraocular lenses into eyes with natural lenses for the correction of refractive error, this study seems to indicate a safe and predictable method for the correction of very high myopia within the 2-year period patients were followed. The ARS technique deserves further study through clinical trials with a significantly longer follow-up period."

For more information about the study, go to http://www.eyenet.org/aaoweb1/Newsroom/1152_2709.cfm