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Lens exchange carries slightly elevated risks, study finds

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Refractive lens exchange is highly effective in improving patients’ uncorrected vision, but the procedure carries elevated risks for sight-threatening complications, according to a retrospective study. These risks “underlie the need for appropriate patient selection,” the study authors suggest.

Noel Horgan and colleagues at Waterford Eye Clinic reviewed the charts of 62 eyes of 37 patients who underwent small incision phacoemulsification refractive lens exchange (RLE) for the correction of high myopia. All patients who had undergone RLE between January 1990 and December 2001 were recalled for a follow-up exam that included dilated retinal examination with scleral indentation.

The mean patient age at time of surgery was 45.3 years old. Preoperative refractive error ranged from –7 D to –22.75 D. Best corrected Snellen visual acuity was 6/12 or better in 48 eyes before surgery. Six eyes were amblyopic, and myopic macular degenerative changes were seen in seven study eyes preoperatively.

RLE was performed through a limbal 3.2-mm incision, with a continuous curvilinear capsulorrhexis of 5.5-mm to 6-mm and lens extraction by low-powered phaco. Most patients received a PMMA IOL in the bag after their incisions were widened to 6.5 mm.

A posterior chamber IOL was implanted in 46 eyes; 16 eyes did not receive an IOL. The authors noted that those cases were performed earliest in the series, before the “ready availability of low powered, plano or minus-powered IOLs.”

Two cases of retinal detachment occurred at intervals of 2 months and 5 months following uncomplicated RLE procedures. Estimates of retinal detachment risk in an unoperated, highly myopic population vary from 0.4% to 0.68% per person-year, which in a group of 37 patients would predict an occurrence of between 0.79 and 1.34 cases of retinal detachment in the time span covered by this study, the authors calculated.

YAG laser posterior capsulotomy was performed in 38 eyes (61%), but it did not represent a risk for retinal detachment, the authors said.

The study is published in the June issue of the British Journal of Ophthalmology.