Risk/benefit ratio for lens exchange in high myopia too high, surgeons say

The risk/benefit ratio for clear lens extraction in patients with high axial myopia is too high for the procedure to be warranted, a group of European ophthalmologists said in an editorial.

in the February issue of Spektrum der Augenheilkunde, Mario Stirpe, MD, and coauthors noted that in the past 20 years, clear lens extraction — also referred to as refractive lens exchange (RLE) — has been suggested by several authors as a treatment for the correction of high axial myopia. However, “the increased risk rates of retinal detachment for high myopia and cataract extraction are probably to be additive; therefore, high myopic eyes are significantly more exposed to postoperative complications,” the authors said.

Because there are only a few reports on the vitreoretinal complications of RLE, most conclusions have been derived from studies on retinal detachment that occurred after cataract extraction in high myopic eyes, the authors said. Intraoperative observations and recent studies of the macular area by means of optical coherence tomography allowed the detection in these eyes of a thin layer of epiretinal tissue strictly adherent to the retina involved by staphylomas, the authors added.