Surgeon proposes microincision refractive lens exchange

CANCUN, Mexico — Further evidence of the merging of cataract and refractive surgery was offered by a surgeon here at the Central Mexican Cornea and Refractive Surgery Congress.

Refractive lens exchange has been adopted by some surgeons for patients with hyperopia and presbyopia, said Arturo Perez-Arteaga, MD. At the same time, microincision cataract surgery is gaining in popularity “because it is an astigmatically neutral procedure, because it has better surgical control and wound stability and therefore, a faster visual rehabilitation for the patient,” he said.

Dr. Perez-Arteaga proposed merging the two techiques into a procedure he calls MIRLEX, or microincision refractive lens exchange.

“MIRLEX is the extraction of the clear lens and the implantation of a micro-IOL with the microincision technique, but for refractive purposes,” he told Ocular Surgery News.

The most important aspect of the procedure is proper patient selection, Dr. Perez-Arteaga said. Surgeons should choose healthy eyes, avoid younger patients and ensure the use of good technology and phacoemulsification techniques.

“The minimally invasive technique is a reality, and the surgical trauma to a high myope or high hyperope is minimal,” Dr. Perez-Arteaga said. “Strict selection criteria rules must be followed.”

He said in his country, the availability of rollable IOLs has presented a problem. “Sometimes because I can’t find the exact IOL power, I have to extend the incision and implant a traditional IOL. I hope in the future … better distribution of rollable IOLs will be available,” he said.

The procedure is still in its infancy, and long-term follow-up with the IOL itself is also warranted, Dr. Perez-Arteaga said.

“The rate of posterior capsular opacification, the long-term optics of the material, the fibrosis and capsular contraction are still unknowns,” he said.