Cataract surgery in highly myopic eyes corrected by phakic anterior chamber angle-supported lenses

Purpose: To assess the incidence of cataract, potential causes of its devel opment, and the outcome of cataract surgery after previous implantation of phakic angle-supported anterior chamber intraocular lenses (AC IOLs) in hig hly myopic patients. Setting: Institute Oftalmologico de Alicante, Department of Refractive Surg ery, Spain. Methods: Two hundred sixty-three highly myopic phakic eyes of 160 patients had implantation of a phakic AC IOL. Follow-up was up to 8 years (range 38. 4 to 103.2 months). Eyes that subsequently developed cataract had cataract extraction and were studied during follow-up for clinical association to ot her preoperative or postoperative data. Cataract surgery was performed afte r phakic IOL explantation by phacoemulsification and posterior chamber IOL (PC IOL) implantation (Domilens-Chiron AL3). Results: Nuclear cataract developed in 9 cases (3.42%) a mean of 42.91 mont hs +/- 17.7 (BD) after phakic AC IOL implantation. Final best spectacle-cor rected visual acuity (BSCVA) was not significantly different from that afte r phakic AC IOL implantation (P = .25, paired Student t test). Mean endothe lial cell loss after cataract surgery was 6.87% +/- 0.42% cells/mm(2). Age at implantation of older than 40 years and axial length greater than 30.0 m m were the 2 factors significantly related to nuclear cataract development (r = 1.69 and 1.98, respectively; P < .05). Conclusions: There is a potential risk of nuclear cataract development afte r phakic AC IOL implantation to correct high myopia in patients cider than 40 years and with very high (greater than 30.0 mm) axial myopia. Phakic IOL explantation, phacoemulsification, and PC IOL implantation successfully re solved this complication. The benefits in terms of BSCVA and spherical equi valent obtained after phakic AC IOL implantation were preserved after catar act surgery. (C) 2000 ASCRS and ESCRS.