1. Results of phacoemulsification
in high myopia
Kumar Vinod, Dushin Nicholai Vasilievich, Isufaj Edmond
Ophthalmic unit, Skhodnya city hospital, Moscow region
Department of Ophthalmology, Russian people’s friendship
university, Moscow, Russia.

2. Introduction
Cataract and myopia :
 Early onset of cataract in myopic eyes
 Cataract in myopic eyes constitutes 5-20% of all cataract cases [ Zuev A.V., 1995]
 Cataract and myopia co-exists in 7.2 to 55 % cases [Erichev VP et al.,2003]
Complicating factors:
 Peripheral and central choreoretinal dystrophies
 Liquefaction of vitreous body (VB)
 Posterior vitreous detachment (PVD)
 Weak Zinn’s ligaments unstable capsular bag  lens dislocation
Сcharacteristics of cataract surgery in myopic eyes:
 Complication rates are higher by 1.5 to 2 times
 Anatomical changes after cataract surgery  anterior movement of PC and
VB, volume increase of VB and increase in height of PVD  high risk factors
for retinal detachment (RD), cystoid macular edema and posterior capsule
opacification (PCO) [Erie JC et al,2006; Tuft SJ et al.,2006; Ripandelli G. et al.,2007 ]
Small incision cataract surgery in myopic eyes:
 Closed chamber surgery+fluidics+use of viscoelastic material  play key role
in preventing forward movement of the VB, reduce the incidence of PVD and
RD [Ravalico G. et al.,2003; Gavris MC et al.,2004; Ji YH et al.,2005; Alio JL et al.,2007 ]
 Early rehabilitation

3. Purpose, Design and Setting
Purpose: To investigate surgical
outcome of phacoemulsification
in high myopic eyes.
Design: Retrospective consecutive
interventional study.
Setting: Ophthalmic unit, Skhodnya city
hospital, Moscow region;
Department of Ophthalmology,
Russian people’s friendship
university, Moscow, Russia.

4. Participants
Patient demographics
Patients (male/female) 33 (14/31)
Eyes 45
Average age in yrs. (range) 71.0 + 5.4 (63 to 88)
Inclusion criteria cases having axial length
>25.0mm in one or both
eyes
Exclusion criteria cases with previous
refractive surgery

5. Methods and Intervention
Preoperative Snellen’s visual acuity, slit-lamp examination, intraocular
evaluation pressure (IOP) readings with Maklakov’s tonometry
IOL power
calculation SRK/T formula, use of surgeon’s personalized A-constant
Complicating hypermature cataract (7 eyes/15.5%), glaucoma (6/13.3),
factors small rigid pupil (5/11.1), lens swelling (4/8.9), pseudo-
exfoliation (4/8.9), weak Zinn’s ligaments (3/6.7)
Intervention Phacoemulsification through 2.8 mm clear corneal incision
and implantation of an IOL (out of these combined
glaucoma and cataract surgery – 2 eyes)
Outcome visual acuity, postoperative spherical equivalent (SE),
measures PCO, need for YAG laser capsulotomy, incidence of RD
Avg. follow-up 10.4 months + 9.6 months (range 3 months to 4.3yrs)
period

6. Results:
visual acuity, SE
Visual acuity SE
14
90
80
Number of cases %
12
Number of cases
70
60 10
50
40 8
30
6
20
10
4
0
1st day 1 w eek 1 month 3 months
2
<0.1 0.1-0.25 0.3-0.5 >0.5
0
-7 -4 -3 -2 -1 0 1 2 5
Post operative follow up period Post operative refraction
SE +/-1.0D. = 15 eyes (33.3%)
SE +/-2.0D. = 32 eyes (71.1%)

7. Results:
Intraoperative observations and complications
S. No. Observations and complications Number %
of eyes
1 Need for anterior capsule staining 37 82.2
(used trypan blue)
2 Pupil stretching 5 11.1
(used polymer iris hooks)
3 Pupil constriction during phacoemulsification 3 6.7
4 Posterior capsule rupture with vitreous loss 1 2.2
(iris-claw IOL fixed at the back of iris)

8. Results:
Postoperative observations
Number
S. No. Observations %
of eyes
Early postoperative period
1 No complications observed 37 82.2
2 Descemetitis (striates, folds) 3 6.7
3 Exudative reaction in anterior chamber 2 4.4
4 High IOP 1 2.2
Late postoperative period
1 PCO reducing visual acuity 7 15.5
YAG laser capsulotomy done
2 5 11.1
(avg. period: 70 +/-23 weeks)
3 Retinal detachment 0 0

9. Conclusions
 In patients with high myopia and cataract
phacoemulsification with implantation of
posterior chamber intraocular lens is a
safe and effective surgical procedure
which solves both visual problem and
refractive deficiency.

10. Conclusions
 In patients with high myopia and cataract
phacoemulsification with implantation of
posterior chamber intraocular lens is a
safe and effective surgical procedure
which solves both visual problem and
refractive deficiency.