Myopic keratophakia considered alternative for correction of high myopia

San Francisco-Correction of high myopia with a phakic IOL or by clear lens exchange does pose some risk for patients because these methods are intraocular procedures. To avoid the associated risks of IOL surgery-such as infection, cataract formation in the case of phakic lenses, possible endothelial damage, pupil ovalization, zonular problems, and retinal problems, surgeons might want to consider myopic keratophakia and excimer laser ablation instead, explained Luis Antonio Ruiz, MD.

Dr. Ruiz, a cataract and refractive surgeon from Bogota, Colombia, showed a video demonstrating this technique in a patient with high myopia and then shared the long-term results of 13 patients who underwent this procedure, during the Innovator's Session at the American Society of Cataract and Refractive Surgery annual meeting.

Dr. Ruiz presented the results of 21 eyes of 13 patients with a mean age of 33 years (range, 17 to 42) who underwent the procedure.

The mean preoperative sphere was –13.55 D (range, –0.75 to –23 D). There were three cases of low myopia but high astigmatism.

The mean cylinder was –8.5 D. The preoperative spherical equivalent (SE) was –15.36 D (range, –4.26 to –23.5 D). The average follow-up was 4.4 years (range, 1 to 7 years).

After myopic keratophakia, the postoperative mean sphere improved to –0.63 D and the postoperative mean cylinder was –0.81 D. The mean SE went down to –0.99 D.

Uncorrected visual acuity (UCVA) improved from 20/400 on average preoperatively to a mean of 20/40. Best-corrected visual acuity also increased slightly in these 21 eyes, explained Dr. Ruiz.

When Dr. Ruiz compared the best spectacle-corrected visual acuity (BSCVA) preoperatively to the UCVA postoperatively, in many cases the postoperative UCVA was better than the preoperative BSCVA.

Dr. Ruiz also showed some examples of corneal topography before and after myopic keratophakia was performed.

"We can change asphericity of the cornea to reduce spherical aberrations with high degrees of correction," he said.

The advantages of myopic keratophakia include safety, a large optical zone and transition zone, and improved UCVA. Nine eyes underwent enhancements, which were easy to perform, and contrast sensitivity improved in most cases.

"Now we have a really good option for treatment of high myopia," Dr. Ruiz concluded.