Retinal detachment after clear lens extraction for high myopia - Seven-year follow-up

Objective: To prospectively evaluate the incidence of complications, partic ularly retinal detachment, 7 years after clear lens extraction (CLE) for my opia greater than -12 diopters (D). Design: Extended follow-up of noncomparative case series. Participants: Fifty-two eyes of 30 patients with preoperative myopia greate r than -12 D, best-corrected visual acuity (BCVA) of 20/100 or better, and intolerance of contact lenses. Intervention: Patients with lattice degeneration, retinal tear, or hole und erwent photocoagulation before CLE. The authors performed phacoemulsificati on through a 3.2-mm-wide incision using primary irrigation and aspiration, widened the incision to 6.5 mm, and implanted a one-piece polymethyl methac rylate intraocular lens (IOL). Main Outcome Measures: The BCVA, uncorrected visual acuity (UCVA), stabilit y of spherical equivalent (SE), neodymium:YAG (Nd:YAG) capsulotomy rate, an d complications (especially retinal detachment). Results: At 7 years, the SEs of 29 eyes (59.1%) were within +/-1.0 D of emm etropia and 42 eyes (85.7%) were within +/-2.0 D. Mean SE was -1.01 D (+/-0 .94). At 7 years, mean UCVA was 20/80 compared with 20/66 at 1 year. BCVA a nd UCVA were better in eyes with open capsules versus intact capsules. Duri ng the 7 years, 30 eyes (61.2%) required capsulotomy for opacification. Mea n time for capsulotomy was 48.4 months after CLE. The authors performed ten argon laser retinal treatments after surgery, with all but one in the firs t postoperative year. The overall incidence of posterior Vitreous detachmen t was 16.3%. The incidence of retinal detachment during the 7 years was 4 o f 49 eyes, or 8.1% (vs. 2.0% at 4 years). One patient had bilateral retinal detachments. Conclusion: Despite advances in surgical technique, retinal detachment rema ins a major concern after CLE for high myopia. In the authors' series, the incidence of retinal detachment after CLE was nearly double that estimated for persons with myopia greater than -10 D who do not undergo surgery. Alth ough CLE has advantages, including rapid and predictable visual rehabilitat ion, stable refraction, the ability to replace the IOL, and often superb op tical quality with no irregular astigmatism, it is invasive and can result in severe vision toss. Long and continuous follow-up of the outcomes of CLE for high myopia is absolutely necessary before the authors can consider CL E as a routine option for patients with high myopia.