RLE for high myopia considered safe, effective in short term

September 15, 2004

San Diego-With the availability of foldable IOLs able to correct up to -31 D of spherical error, refractive lens exchange (RLE) for high myopia is now an option for patients hoping to achieve a good refractive outcome. However, patients will need to be monitored long term for potential complications, such as retinal detachments and posterior capsular opacification (PCO), explained Thomas Kohnen, MD, who spoke during the American Society of Cataract and Refractive Surgery annual meeting.

In a small study at his clinic in Frankfurt, Germany, Dr. Kohnen treated 51 eyes with RLE using five different hydrophobic, acrylic lenses with varying lens powers for correction of moderate to high myopia. Patients had a mean spherical equivalent (SE) of -12.64 ± 6.32 D (range, -3.63 to -32.5 D). Mean spherical error was -12.24 ± 6.27 D (range, -3.25 to -31 D) and mean cylinder was -1.4 ± 0.9 D (range, +1 to -3.75 D).

Patients had a mean age of 54 years and more females (70%) than males were enrolled in the study, said Dr. Kohnen, professor of ophthalmology, department of ophthalmology, Johann Wolfgang Goethe-University, Frankfurt, Germany.

"The aim of this small study was to evaluate RLE for high myopia," Dr. Kohnen said. "Of course, we haveto control sphere and astigmatism and achieve refractive stability to achieve a good outcome."

Dr. Kohnen used five different foldable lenses in his study. The breakdown depended on the range of correction.

To prevent PCO and the need for Nd:YAG capsulotomy in these patients, IOLs were chosen with square, truncated optic edge designs. Dr. Kohnen also recommended rigorous cortical clean-up, posterior capsule polishing, and continuous curvilinear capsulorhexis overlap on the optic edge to avoid PCO. To minimize internal reflections and glare, he used the Sensar lens with its OptiEdge design or Alcon designs with frosted-edge finishing.