Small incision clear lens extraction for correction of high myopia

PURPOSE: To evaluate the effectiveness, predictability, and safety of clear lens extraction in the correction of high myopia. SETTING: Kartal Education and Research Hospital, Istanbul, Turkey. METHODS: This retrospective study comprised 56 eyes of 30 patients who had clear lens extraction to correct myopia of 12.00 diopters (D) or more. Small incision clear lens extraction using an anterior chamber maintainer was performed and low-power posterior chamber intraocular lens (IOL) was implanted. The mean postoperative follow-up was 40.2 +/- 11.9 months. RESULTS: Uncorrected visual acuity improved in 94.6% of eyes. Best-corrected visual acuity (BCVA) improved in 37 eyes (66%); 27 (48.2%) gained two or more lines. The percentage of eyes achieving a BCVA of 20/40 or better increased from 26.7% preoperatively to 58.9% postoperatively. Of the eyes, 38 (67.8%) were within +/- 1.00 D of targeted refractive error and 52 (92.8%) were within +/- 2.00 D. Posterior capsule tear with vitreous loss occurred in one eye (1.7%). During the follow-up, retinal detachment (RD) occurred in 2 eyes (3.5%). CONCLUSIONS: Clear lens extraction and IOL implantation was effective and had an acceptable predictability and a low morbidity in correcting high myopia. Regular retinal examination is necessary to prevent postoperative RD.     

Myopic implant of the posterior chamber using a flexible Collamer lens

BACKGROUND: The purpose of this study was to report results, effectiveness and safety of implanting a negative collagen/HEMA copolymer posterior chamber phakic intraocular lens in moderate to highly myopic eyes. MATERIAL AND METHODS: 23 eyes from 12 patients with a mean preoperative spherical equivalent refraction of - 10.94 +/- 5.97 D underwent a refractive procedure with the Staar ICL trade mark posterior chamber phakic intraocular lens. The average follow-up was 12.9 +/- 7.4 months (range 4 - 24 months). Preoperative and postoperative uncorrected and best corrected visual acuity, subjective refraction, intraocular pressure, keratometry, ICL trade mark centration and anterior subcapsular opacities were evaluated. RESULTS: Postoperative uncorrected visual acuity improved in all eyes. The best corrected visual acuity increased from 0.82 +/- 0.39 preoperatively to 1.05 +/- 0.24 postoperatively. The gain in visual acuity was statistically significant (Student t-test, p = 0.0097). The mean postoperative spherical equivalent refraction was - 0.82 +/- 1.42 D (p < 0,0001). The mean postoperative intraocular pressure was 15.65 +/- 2.72 mm Hg. The intraocular contact lens remained well centred in all eyes and no anterior subcapsular opacities were observed. Three patients underwent transcient complication without affecting the visual outcome. CONCLUSION: The use of a posterior chamber phakic intraocular lens in myopic eyes is a safe procedure to correct moderate to high myopia. Long-term results are still unknown.     

Clear lens extraction in high myopia

PURPOSE: To evaluate effectiveness and safety of clear lens extraction in high myopia. MATERIAL AND METHODS: 39 eyes of 26 patients had clear lens extraction and implantation of PC IOL. The mean preoperative spherical equivalent was -17.0 D sph, mean follow-up was 19.4 months. IOL calculations were performed using SRK II formula for target refraction -2.0 or -3.0 D sph. RESULTS: The mean postoperative spherical equivalent was -3.3 D sph. The best corrected visual acuity improved in 84.6% of eyes. The percentage of eyes achieving BCVA 0.5 or better increased from 23% preoperatively to 59% postoperatively. In 7 eyes (18%) posterior capsule opacification occurred. Two years after the surgery in one eye retinal detachment appeared, which was successfully treated. CONCLUSION: Clear lens extraction with PC IOL implantation in high myopia gives good results with low number of complications.     

超声乳化透明晶状体吸除术治疗高度近视的临床研究

目的探讨超声乳化透明晶状体吸除联合人工晶状体植入术治疗高度近视的有效性和安全性.方法对26例(36只眼)高度近视患者行巩膜隧道切口超声乳化透明晶状体吸除联合人工晶状本植入术.平均年龄53.9岁,术前矫正视力0.2～1.0,平均近视度数(-13.1l±4.33)D,平均散光度数(0.72±0.91)D,平均眼轴长度(28.02±2.14)mm,平均植入人工晶状体屈光度数(+8.62±4.76)D.结果术后所有患者裸眼视力提高;25只眼(69.4%)裸眼视力≥0.5;27只眼(75.0%)矫正视力较术前提高.35只眼(97.2%)矫正视力≥0.5.术后平均近视度数(-1.51±0.60)D,平均散光度数(0.64±0.80)D.术后平均随访时间23.5个月.术后发生晶状体后囊膜混浊2只眼(5.6%),未见视网膜裂孔、视网膜脱离及黄斑囊样水肿.结论超声乳化透明晶状体吸除联合人工晶状体植入术是矫治高度近视安全、有效的方法,具有术后视力好、并发症少、预测屈光状态准确性及稳定性好等优点.     

Management of pseudophakic bullous keratopathy by combined Descemet-stripping endothelial keratoplasty and intraocular lens exchange

PURPOSE: To evaluate visual recovery results in 11 patients with anterior pseudophakia and corneal endothelial dysfunction who had Descemet-stripping endothelial keratoplasty (DSEK) combined with anterior chamber intraocular lens (IOL) removal and scleral fixation of a posterior chamber IOL. SETTING: Department of Ophthalmology, District Railway Hospital Katowice, Katowice, Poland. METHODS: Eleven consecutive patients had DSEK combined with IOL exchange. Corneal transparency, central corneal thickness (CCT), endothelial cell density (ECD), visual outcomes, and complication rates were measured during the follow-up. RESULTS: The mean age of patients was 76 years. All corneas remained clear during the mean 19.3-month follow-up. At the last visit, the mean uncorrected visual acuity was 0.16 (range 0.001 to 0.50) and the mean best corrected visual acuity, 0.36 (range 0.001 to 0.80). The mean spherical equivalent was +0.30 diopter (D) (range -2.00 to +2.25 D) and the mean astigmatism, 2.20 D (range 1.25 to 3.00 D). Three eyes with endothelial disk detachment required reinjection of air. Corneal rejection was observed in 1 eye 3 months postoperatively. Two eyes had flap erosion over the fixation suture. The mean CCT was 0.837 microm preoperatively and 0.605 microm postoperatively. The mean ECD was 3198 cells/mm(2) in donor lenticules and 2048 cells/mm(2) at the last follow-up visit. Endothelial cell loss was 36%. CONCLUSION: Descemet-stripping endothelial keratoplasty combined with anterior chamber IOL replacement with a scleral-fixated posterior chamber IOL was a safe method for the management of pseudophakic bullous keratopathy.     

Phakic posterior chamber intraocular lens for high myopia

PURPOSE: To evaluate the efficacy, predictability, stability, and safety of the surgical correction of high myopia using a phakic posterior chamber intraocular lens (PPC IOL). SETTING: Centro Oftalmológico de Valencia-CEOVAL, Valencia, Venezuela. METHODS: A retrospective study was performed to analyze 18 eyes of 12 patients who had implantation of a modified PPC IOL, the implantable contact lens (ICL), for the treatment of high myopia. The target postoperative spherical equivalent (SE) refraction was emmetropia. RESULTS: The mean follow-up was 26.6 months +/- 11.3 (SD) (range 12 to 36 months). The mean preoperative SE was -15.27 +/- 3.47 diopters (D) (range -10.0 to -21.25 D) and the mean postoperative SE, -0.62 +/- 0.81 D (range -2.75 to +0.75 D). Eleven eyes (61.1%) had an SE within +/-1.00 D of emmetropia. The best spectacle-corrected visual acuity was maintained or improved in all except 1 eye, which lost more than 2 lines of Snellen visual acuity. Two eyes (11.1%) developed pupillary block the first day after surgery. Four eyes (22.2%) had moderate pigmentary dispersion. Two eyes (11.1%) had lens opacification, 1 with mild peripheral anterior capsule opacification and the other eye with central anterior subcapsular opacification. One eye (5.5%) had a significant decrease in anterior chamber depth after surgery. CONCLUSIONS: Implantation of an ICL was effective for the correction of high myopia. Predictability must be improved and the long-term safety of the ICL determined. The main concerns over potential cataract formation, pigmentary dispersion, and angle-closure glaucoma remain.     

Combined posterior chamber phakic intraocular lens and laser in situ keratomileusis: bioptics for extreme myopia.

PURPOSE: To examine the efficacy, predictability, stability, and safety of combined posterior chamber phakic intraocular lens (IOL) implantation and laser in situ keratomileusis (LASIK) in eyes with extreme myopia. METHODS: We analyzed the results of 67 eyes that received a posterior chamber hydrogel-collagen plate phakic IOL (STAAR Collamer Implantable Contact Lens) and also underwent secondary LASIK for the correction of extreme myopia. Mean follow-up was 3 months after the LASIK portion of the procedure (range, 1 day to 6 mo after LASIK). RESULTS: Mean preoperative spherical equivalent refraction was -23.00 +/- 3.60 D (range, -18.75 to -35.00 D), and mean refractive cylinder was 1.50 +/- 1.20 D (range, 0 to 5.00 D). Mean spherical equivalent refraction after IOL implantation and before LASIK was -6.00 +/- 2.80 D (range, -2.00 to -14.38 D) and mean refractive cylinder 1.50 +/- 1.10 D (range, 0 to 5.00 D). Mean postoperative spherical equivalent refraction at last examination after the LASIK portion of the two-part phakic IOL-LASIK procedure was -0.20 +/- 0.90 D (range, +1.75 to -5.13 D), and mean refractive cylinder was 0.50 +/- 0.50 (range, 0 to 2.25 D). Eighty-five percent (57 eyes) were within +/- 1.00 D and 67% (45 eyes) were within +/- 0.50 D of emmetropia at last examination. The refractions remained stable with a statistically insignificant change (P > .05 at each interval) during follow-up. Postoperative uncorrected visual acuity at last examination was 20/20 or better in 3% (2 eyes) and 20/40 or better in 69% (46 eyes). A gain of 2 or more lines of spectacle-corrected visual acuity was seen in 51 eyes (76%) and no eyes lost 2 or more lines of spectacle-corrected visual acuity at last examination. CONCLUSION: Combined posterior chamber phakic IOL implantation with the STAAR Collamer plate lens and LASIK (bioptics) is an effective and reasonably predictable method for correcting myopia from -18 to -35 D. Gains in spectacle-corrected visual acuity were common, and results demonstrated good short-term safety and refractive stability.     

Surgical correction of severe myopia with an angle-supported phakic intraocular lens

PURPOSE: To evaluate the effectiveness, predictability, and safety of a fourth-generation angle-supported anterior chamber phakic intraocular lens (IOL) in patients with severe myopia. SETTING: Refractive Surgery and Cornea Unit, Alicante Institute of Ophthalmology, Miguel Hernández University School of Medicine, Alicante, Spain. METHODS: In this prospective study, 23 eyes (16 patients) with a mean preoperative myopia of -19.56 diopters (D) +/- 1.76 (SD) (range -16.75 to -23.25 D) were implanted with the ZSAL-4 phakic IOL. Basic examinations were performed before and after surgery in all patients. Eighteen eyes were also studied by clinical specular microscopy, and the endothelium was analyzed for cell density, coefficient of variation in cell size, and hexagonality. The location of the IOL in the anterior chamber was evaluated in 10 eyes by A-scan biometry. To evaluate haptic geometry, a theoretical mechanical model was used. The follow-up was 24 months in all patients. RESULTS: Uncorrected visual acuity was 20/40 or better in 13 eyes (56.0%) 12 months after surgery and in 14 eyes (60.8%) at 24 months. Best spectacle-corrected visual acuity improved 0.19 at 12 and 24 months (0.1 = 1 line) from preoperative values. The efficacy index was 1.12 at 24 months and the safety index, 1.45. The mean postoperative spherical equivalent was -0.65 +/- 0.65 D at 24 months. The postoperative spherical equivalent was within +/-1.00 D of emmetropia in 19 eyes (82.6%) at 12 and 24 months. The mean endothelial cell loss was 3.50% at 12 months and 4.18% at 24 months. The coefficient of variation in cell size decreased from 0.34 before surgery to 0.28 at 24 months after surgery. The IOL was located 0.79 +/- 0.24 mm in front of the crystalline lens. Postoperative complications included night halos in 6 eyes (26.1%) at 12 and 24 months and pupil ovalization in 4 eyes (17.4%). Intraocular lens rotation was observed in 10 eyes (43.5%) at 24 months. Two eyes (8. 7%) developed a slight inflammatory response during the first 6 months. Our mechanical model predicted that the compression forces against the angle structures were greater at the first footplate than at the second. CONCLUSIONS: Implantation of the ZSAL-4 IOL in the anterior chamber of phakic eyes was effective and predictable in correcting severe myopia. However, the ZSAL-4 did not prevent pupil ovalization, IOL rotation, or low-grade postoperative uveitis. Improvements in haptic design following our mechanical model could decrease these haptic-related complications.     

前房型人工晶状体植入治疗高度近视眼

目的探讨前房内植入房角支撑型硬性人工晶状体治疗高度近视眼的预测性、安全性和有效性。方法40例(76只眼)高度近视眼患者,术前屈光度数为-9.50～-26．25 D,平均(-15．89±3.78)D,术前最佳矫正视力0．5～1．0,植入房角支撑型硬性人工晶状体(Phakic 6H型)矫正高度近视眼,平均随访时间为1年。术前术后观察裸眼视力、矫正视力、届光度数、眼压、角膜内皮和眼前节的变化等。结果术后1年,裸眼视力为0．3～1．5,最佳矫正视力0．5～1．5,残余屈光度数为-2.00～+0．50 D,平均(-0．40±0．64)D,屈光度数在≤±1．00 D以内占96．1％。术前和术后1年角膜内皮细胞计数分别为(3174±248)个／mm2和(3067±320)个／mm2,两者比较,差异有统计学意义(P<0．01)。术前和术后1年眼压分别为(16．12±2.32)mm Hg(1mm Hg=0．133 kPa)和(15．29±3．38)mm Hg,两者比较,差异有统计学意义(P<0．05)。4只眼主诉有眩光。2只眼瞳孔呈竖椭圆形,2只眼晶状体下偏约1．0 mm。1例患者双眼在术后8个月时曾出现黄斑区出血。结论有晶状体眼房角支撑型硬性人工晶状体治疗超高度近视眼安全有效,且预测性好,值得进一步临床研究,长期疗效和安全性有待进一步观察。     

Results of implantation of a Worst Iris Claw Lens for correction of high myopia

BACKGROUND: The purpose of this clinical study was to evaluate refraction, best visual acuity and anterior chamber flare after implantation of a Worst Iris Claw Lens to correct high myopia. PATIENTS AND METHODS: From September 1996 to February 1999 the implantation of a Worst Iris Claw lens was performed on 44 highly myopic phakic eyes of 28 patients. Data after 6 weeks and 6 months follow-up were assessed. RESULTS: The mean preoperative spherical equivalent was--17.35 +/- 3.57 dpt and 6 months after implantation 79% of the eyes were within +/- 1.0 dpt of target refraction. The mean best corrected visual acuity increased from 0.43 preoperatively to 0.65 postoperatively and 6 months after the treatment there was no flare (< 10 photons/ms) in 21% and a mild anterior chamber flare (10-80 photons/ms) in 76% of the treated eyes. The median laser flare was 20 p/ms. CONCLUSIONS: In conclusion, implantation of a Worst Iris Claw lens has proved to be a precise method to correct high myopia. No or mild anterior chamber flare and a good visual acuity were measured in most eyes 6 weeks and 6 months after surgery. Longer follow-up periods are needed to assess the long-term safety and efficiency.     

高度近视白内障超声乳化摘除及后房型人工晶体植入术

评价高度近视白内障超声乳化摘除及后房型人工晶体植入术的疗效。方法对２１例老年性、并发性和先天性白内障施行巩膜隧道切口超声乳化吸除,通过３．２ｍｍ切口植入折叠式人工晶体,通过５．５ｍｍ切口植入ＰＭＭＡ硬性人工晶体。     

Refractive lens exchange combined with pars plana vitrectomy to correct high myopia

PURPOSE: To describe the results of refractive lens exchange (RLE) combined with simultaneous pars plana vitrectomy (PPV) in the management of severe myopia. METHODS: This retrospective study comprised 14 eyes of eight patients who had RLE to treat myopia of -19.0+/-5.4 diopters (D). Phacoemulsification, posterior chamber intraocular lens (IOL) implantation, and standard three-port vitrectomy were performed. Mean postoperative follow-up time was 30 months (range 12-49). RESULTS: The postoperative best-corrected visual acuity (BCVA) was 0.68+/-0.23 compared to 0.37+/-0.24 preoperatively. There was no postoperative decrease in visual acuity in any eye. Mean postoperative spherical equivalent was -0.7 D (+/-1.6). At 30 months mean follow-up time, the spherical equivalents of nine eyes (64.3%) were within +/-1 D of emmetropia. There was no significant change in astigmatism due to operative procedures. During the 30 months follow-up period three eyes (21.4%) required neodymium : yttrium-aluminium-garnet (Nd : YAG) capsulotomy for posterior capsule opacification. No retinal detachments or cases of cystoid macular oedema (CME) were observed during the follow-up. CONCLUSION: RLE was effective in correcting severe myopia. The simultaneously performed PPV may reduce the risk of postoperative retinal detachment. This was a pilot study, to draw definitive conclusions a prospective study has to be initiated.     

Intraocular lens power calculation using ray tracing following excimer laser surgery

PURPOSE: To evaluate intraocular lens (IOL) power calculation using ray tracing in patients presenting with cataract after excimer laser surgery. METHODS: Ten eyes of seven consecutive patients who presented for cataract surgery following excimer laser treatment without any pre-refractive biometry data were enrolled in this prospective clinical study. Preoperatively, IOL power calculation was performed using a ray tracing software called OKULIX. Keratometry data (C-Scan) were imported and axial length (IOLMaster) was entered manually. Accuracy of IOL power calculation was investigated by subtracting attempted and achieved spherical equivalent. RESULTS: Mean spherical equivalent was -3.51+/-2.77 D (range -10.38 to -0.5 D) preoperatively and -1.01+/-1.08 D (range -2.5 to +0.75 D) postoperatively. Mean error was 0.31+/-0.84 D, mean absolute error was 0.74+/-0.46 D, and IOL calculation errors ranged from -1.39 to +1.47 D. A total of 40% of eyes were within +/-0.5 D, 70% within +/-1.0 D, and 100% within +/-1.5 D. Three eyes with corneal radii over 10 mm showed calculation errors exceeding +/-1.0 D. Mean best-corrected visual acuity increased from 20/60 to 20/30 postoperatively. Conclusions: IOL power calculation after excimer laser surgery can be difficult, especially when pre-refractive keratometry values are not available. In these cases, ray tracing combined with corneal topography measurements provides reliable and satisfactory postoperative results. However, it is advisable to be careful when calculating IOL power for eyes with corneal radii exceeding 10 mm because of slightly higher prediction errors.     

Efficacy of scleral-fixated 3-looped haptics intraocular lens implantation for surgical management of microspherophakia

AIM: To evaluate the safety and efficacy of scleral-fixated 3-looped haptics intraocular lens (IOL) implantation for surgical management of microspherophakia. METHODS: A retrospective case series include 10 microspherophakic patients (15 eyes) who underwent lens removal plus a modified surgical treatment of scleral-fixated 3-looped haptics IOL implantation. The primary outcomes involved visual acuity, intraocular pressure (IOP). Secondary outcomes were spherical equivalent (SE), anterior chamber depth (ACD), corneal endothelial cell density and postoperative complications. RESULTS: After a postoperative follow-up of 17.60±15.44mo, improved visual outcomes can be observed. The uncorrected distance visual acuity (UCVA) logMAR improved from 1.54±0.59 preoperatively to 0.51±0.35 postoperatively (P=0.001), and best corrected visual acuity (BCVA) logMAR improved from 0.97±0.91 preoperatively to 0.24±0.23 postoperatively (P=0.003). Moreover, the SE decreased from -9.58±7.47D preoperatively to -0.65±2.21 D postoperatively (P<0.001). In terms of safety profile, the average IOP decreased from 21.10±12.94 mm Hg preoperatively to 14.03±3.57 mm Hg postoperatively (P=0.044), and the previously elevated IOP of three eyes decreased to the normal range. The ACD increased from 2.25±1.45 mm preoperatively to 3.35±0.39 mm postoperatively (P=0.017). The density of corneal endothelial cells did not change significantly after surgery (P=0.140). The posterior chamber IOLs were well centered and no severe complications were found. CONCLUSION: Lens removal plus the modified surgical treatment of scleral-fixated 3-looped haptics IOL implantation can help in improvement of visual acuity, which can be regarded as a relative safe method for the surgical management of microspherophakia.     

Laser in situ keratomileusis and photorefractive keratectomy for residual refractive error after phakic intraocular lens implantation

PURPOSE: To determine the visual and refractive outcome of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in eyes with prior posterior chamber phakic intraocular lens implantation for high myopia. METHODS: We studied a series of 37 consecutive eyes of 31 patients who underwent LASIK or PRK for residual refractive error following collamer posterior chamber intraocular lens (IOL) (Staar Surgical Implantable Contact Lens) implantation into a phakic eye. Twenty-eight eyes had LASIK and nine eyes had PRK. Mean follow-up was 8.1 +/- 4.7 months after laser ablation (range, 3 to 18 mo). RESULTS: The preoperative mean spherical equivalent refraction prior to phakic posterior chamber IOL implantation was -17.74 +/- 4.89 D (range, -9.75 to -28.00 D). Following phakic IOL implantation and prior to LASIK or PRK, mean spherical equivalent refraction was -2.56 +/- 2.34 D (range, -0.25 to -8.75 D). One month following LASIK or PRK, mean spherical equivalent refraction was -0.24 +/- 0.52 D (range, -1.50 to +1.50 D), 3 months following LASIK or PRK, mean spherical equivalent refraction was -0.19 +/- 0.50 D (range, -1.50 to +1.00 D). The refraction was within +/-1.00 D of emmetropia in 36 eyes (97.2%) and within +/-0.50 D in 31 eyes (83.7%). Three eyes developed anterior subcapsular opacities several weeks after laser ablation, one eye developed macular hemorrhage 4 weeks after laser ablation, and one eye had corticosteroid induced ocular hypertension. CONCLUSIONS: LASIK or PRK can be used to treat the residual refractive error following posterior chamber phakic IOL implantation.     

Visian Collamer phakic intraocular lens in high myopic Asian eyes

PURPOSE: To evaluate the safety and efficacy of the Implantable Collamer Lens (Visian), a phakic intraocular lens (PIOL), in the correction of high myopia in Asian eyes. METHODS: This prospective study comprised 61 eyes in 40 Chinese patients with mean preoperative manifest spherical equivalent refraction of -14.54 +/- 3.61 diopters (D) (range: -7.00 to -24.75 D) who underwent Visian PIOL implantation from May 2002 to December 2004. The anatomical differences between Asian and Caucasian eyes were compared. RESULTS: Mean follow-up was 13.67 +/- 8.51 months (range: 1 to 32 months). Predictability of the manifest spherical equivalent refraction to within +/- 1.00 D was achieved in 88% of eyes and +/- 0.50 D in 72.5% of eyes. The mean postoperative manifest spherical equivalent refraction was -0.10 +/- 0.74 D, with 97% of eyes maintaining or gaining > or = 1 lines of best spectacle-corrected visual acuity (BSCVA). Two eyes lost 1 line of BSCVA. Retinal detachment developed in 1 eye 15 months after initial surgery. Because of the statistical differences in anterior chamber depth and white-to-white distance between Caucasian and Chinese eyes, the Visian PIOL size was more accurate if the calculation was modified so that 0.5 mm was added to the white-to-white measurement if the anterior chamber depth was < or = 3.0 mm and 1.0 mm to the white-to-white measurement if the anterior chamber depth was >3.0 mm. Initial incorrect sizing using the original nomogram led to the only cataract in our series. CONCLUSIONS: The implantation of the Visian PIOL for correcting moderate to high myopia in Asian eyes shows similar safety and efficacy to the FDA clinical trial of Caucasian eyes. Proper sizing of the Visian PIOL is important and differs slightly in Asian eyes.     

Phakic posterior chamber lenses for high myopia: functional and anatomical outcomes

PURPOSE: To evaluate the functional and the anatomical outcomes after implantation of phakic posterior chamber intraocular lenses (IOLs) in highly myopic eyes. SETTING: Service d'Ophtalmologie, H?pital Purpan, Toulouse, France. METHODS: Fifty-eight eyes of 46 patients that had implantation of phakic posterior chamber lenses for high myopia were evaluated. Predictability, efficiency, safety, and subjective and objective quality of vision were evaluated preoperatively and at least 6 months postoperatively. The effect of the procedure on the cornea, aqueous humor, pupil, anterior chamber angle, crystalline lens, and retina were studied. RESULTS: Mean preoperative myopia was -13.85 diopters (D) +/- 3.1 (SD) (range -8.00 to -19.25 D). Mean postoperative spherical equivalent was -1.22 +/- 0.83 D (range +0.75 to -3.50 D); 56.9% of eyes were within +/-1.00 D of the predicted result, and 77.6% gained 1 or more lines of best corrected visual acuity. All contact-lens-intolerant patients had improved quality of vision for day and night driving, distance vision, and vision under dim illumination. The mean postoperative level of contrast sensitivity without correction was higher than the mean preoperative level with correction. Adverse events were 2 cases of crystalline lens opacification 16 and 18 months after surgery and 2 cases of pigment deposits in the angle with increased intraocular pressure, which was controlled by beta-blockers. CONCLUSION: Implantation of posterior chamber phakic IOLs is effective and predictable; however, long-term follow-up is needed.     

Intraoperative autorefraction for combined phakic intraocular lens explantation and cataract surgery

PURPOSE: To evaluate intraoperative autorefraction during combined phakic intraocular lens (PIOL) explantation and cataract surgery. METHODS: Phakic intraocular lens explantation was followed by crystalline lens emulsification and reformation of the anterior chamber with balanced salt solution. Autorefraction was performed intraoperatively with the Nikon Retinomax 2, and the IOL power was calculated using a formula for myopic eyes: IOL for emmetropia = 1.3 x aphakic spherical equivalent refraction + 1.45. RESULTS: Nineteen myopic eyes of 15 patients with anterior or posterior chamber PIOL (including 6 eyes that had undergone photorefractive keratectomy) were treated. Two months postoperatively, mean spherical equivalent refraction was -0.56+/-0.40 diopters (D) (range: 0 to -1.50 D). CONCLUSIONS: In myopic eyes, intraoperative auto-refraction provided a simple and reliable method to calculate IOL power in combined PIOL explantation and cataract surgery.     

有晶状体眼后房型人工晶状体植入矫正高度近视的临床评价

目的评价有晶状体眼后房型人工晶状体植入矫正高度近视的有效性、安全性及稳定性。方法选取1997年1月至2005年12月在我院就诊高度近视患者113例（216只眼）,平均年龄30岁,均在球周麻醉及表面麻醉下经3．2mm透明角膜切口植入后房型人工晶状体（ICLV2型15例,ICLV4,美国STAAR公司）,随访术前及术后1d、1周及1、3、6、12、24、36个月,随访内容包括裸眼视力、最佳矫正视力、角膜地形图、屈光度数、裂隙灯显微镜检查、眼压、角膜内皮计数等。术前检查等效球面屈光度数（17．78±3．88）D,平均随访18．2个月后观察屈光状态,24．3个月后观察术后并发症。结果所有手术均顺利进行,所有患者裸眼视力均有明显提高,最后一次随访等效球面屈光度数为（-1．00±1．40）D,与预期屈光度数差别±1．00D以内者191只眼（88．4％）,±0．50D以内者165只眼（76．4％）。术前屈光度数在-20．00D以下的有151只眼,与预期屈光度数差别±1．00D以内者145只眼（96．0％）,±0．50D以内者128只眼（84．8％）。随访期间屈光度数差异无统计学意义（P〉0．05）,术后1年最佳矫正视力提高1行及以上168只眼（77．8％）,4只眼（1．85％）下降1行。4只眼（1．85％）发生需手术治疗瞳孔阻滞性青光眼,3只眼（1．39％）发生晶状体前囊下混浊,均行人工晶状体取出,晶状体摘除及人工晶状体植入术,术后最佳矫正视力无下降。结论有晶状体眼后房型人工晶状体植入矫正高度近视具有有效性、安全性及稳定性。（中华眼科杂志,2007,43：1000-1004）     

Refractive lens exchange with an array multifocal intraocular lens

PURPOSE: To prospectively evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after refractive lens exchange (clear lens extraction) followed by posterior chamber implantation of a multifocal intraocular lens (IOL). METHODS: Fifty eyes of 25 patients (mean age 51 years, range 44 to 62 years) with preoperative spherical equivalent refraction between -15.50 and +5.75 D and cylinder between 0 and 1.50 D underwent bilateral implantation of a zonal progressive multifocal IOL (Array, AMO). RESULTS: Eyes were divided into group A (n=24; myopia, average preoperative spherical equivalent refraction -7.11 +/- 3.25 D (-1.75 to -15.50 D), and group B (n=26; hyperopia, average preoperative spherical equivalent refraction +3.04 +/- 1.04 D). Follow-up was 6 months in all eyes. Postoperatively, all eyes of both groups were within +/-1.00 D of target refraction. No eye in group A and three eyes in group B sustained a loss of one line of BSCVA. Forty-seven eyes (94%) remained unchanged or gained one or more lines of their preoperative BSCVA. In all eyes, postoperative UCVA was 20/40 or better. When compared to preoperative, uncorrected near visual acuity improved (statistically significant). All patients achieved uncorrected binocular visual acuity of 20/30 and J4 or better. Patient satisfaction was extremely high; no intra- or postoperative complications were reported. CONCLUSION: Six-month results of implantation of the AMO Array multifocal IOL for refractive lens exchange demonstrated safety, efficacy, and predictability in correcting high ametropia and significant improvement of uncorrected near and distance visual acuity.