SURGICAL-CORRECTION OF HIGH MYOPIA IN PHAKIC EYES WITH WORST-FECHNER MYOPIA INTRAOCULAR LENSES

BACKGROUND: Implanting an anterior chamber intraocular lens in a phaki c eye is an effective surgical procedure for the correction of high my opia. However, the potential risks on the anterior segment structures are not well-known. We conducted a prospective study to evaluate the e ffectiveness, predictability, and safety after Worst-Fechner lenses we re implanted to correct high myopia. METHODS: We studied 32 eyes with preoperative myopia from -9.50 to -27.00 diopters (D) (-16.60 +/- 6.29 D). All 32 eyes were studied by clinical specular microscopy, and the endothelium was analyzed for cell density. Twenty eyes mere additiona lly examined by fluorophotometry for lens transmittance changes. Thirt y eyes were additionally examined using the flare mode of a laser flar e cell photometer for anterior chamber imflammation; the patients were divided into three subgroups of ten eyes each according to when the p ostoperative flare measurements were done: 12 months, 18 months, and 2 4 months. Thirteen phakic eyes with myopia greater than -6.00 D were u sed as a control group for the flare study. The mean follow-up was 18. 3 +/- 8 months (range 6 to 24 mo). RESULTS: Fifty-seven per cent of ey es (16 of 28) had an uncorrected visual acuity of 20/40 or better 12 m onths after surgery, and 58% (10 of 17 eyes) at 24 months. Spectacle-c orrected visual acuity improved: 0.15 at 12 months and 0.16 at 24 mont hs (0.1 = one line) from preoperative values. Visual acuity was stable after 3 months. Eighty per cent of eyes (25 of 31) at 6 months, 75% ( 21 of 28) at 12 months, and 76.5% (13 of 17) at 24 months had been cor rectly planned to within +1.00 D of emmetropia. The refractive results were stable 3 months after surgery. The mean endothelial cell loss wa s 7.2% at 3 months, 10.6% at 6 months, 13% at 12 months, and 17.6% at 24 months after surgery. The mean lens transmittance loss was 0.62% at 3 months, 0.72% at 6 months, 0.82% at 12 months, and 1.03% at 18 mont hs after surgery. Flare values were significantly higher for eyes impl anted with Worst-Fechner lenses than were those of the control group i n all periods under consideration (Mann-Whitney test, p < 0.05). A dec entration greater than 0.5 mm was present in 43% of eyes (14 of 32), a nd halos in 564 (18 of 32). In three eyes (9.3%), fixation of the lens to the iris was not stable. CONCLUSIONS: Our results for the Worst-Fe chner myopia lens confirm earlier findings on the effectiveness of the refractive results. However, our study showed a continual decrease in endothelial cell density a decrease in lens transmittance, and a chro nic subclinical inflammation after the implantation of these lenses. M oreover, decentration was common, and the fixation of the IOL to the i ris was not stable in some eyes.