Refractive surgery for high myopia

Surgical correction of high myopia is indicated in a limited number of cases. Techniques include (epi)keratophakia, keratomileusis and implantation of a negative-power IOL. The iris claw lens, fixed to the midperiphery of the iris, has proved its safety in aphakic eyes. The model has been adapted by giving it a vault in order to make it suitable for implantation in high myopic phakic eyes. The implantation technique and short-term results of patients operated by Worst are presented.     

屈光性晶状体置换手术治疗高度近视眼的长期疗效观察

目的:通过对高度近视眼透明晶状体摘除人工晶状体植入手术后长期疗效观察,评价该疗法的远期效果及安全性。方法:利用非随机的系列病例回顾性研究,对在两年间接受高度近视眼透明晶状体摘除人工晶状体植入的67例(125眼)患者进行了长达6a的随访研究。所有患者均接受了以矫正高度近视眼为目的透明晶状体超声乳化摘除及低读数或负度数人工晶状体囊袋内植入手术。在术后第1,3,6a,分别观察其视力、屈光度、角膜内皮、后发性白内障及视网膜并发症等方面的变化情况。结果:所有手术没有医源性事故发生;接受手术时患者的平均年龄为42.8岁;术前平均近视屈光度为-15.65D。术后6a随访,较术前自戴眶架眼镜矫正视力提高的占75.7%,没有变化的占10.4%,低于术前自戴眶架眼镜矫正视力的占12.2%。44%有后发性白内障发生,需行Nd∶YAG激光后囊膜切开或后囊膜切除手术;1.6%分别在术后5mo和16mo发生视网膜脱离。术后1a角膜内皮丢失率为1.9%,3a为3.2%,6a为5.9%。结论:有术前全面细致的眼部检查、评估和娴熟的超声乳化手术技术的掌控,透明晶状体摘除手术治疗高度近视眼是安全和疗效满意的。     

Refractive surgery for high bilateral myopia in children with neurobehavioral disorders: 2. Laser-assisted subepithelial keratectomy (LASEK).

INTRODUCTION: A subpopulation of children with high myopia and neurobehavioral disorders is noncompliant with spectacle wear and ill-suited to correction using contact lenses. We report the results of refractive surgery in a series of these children treated bilaterally using excimer laser technology. METHODS: Clinical course and outcome data were collated prospectively in a group of 9 children (mean age, 10.2 years; range, 3-16 years) with neurobehavioral disorders exacerbated by chronic noncompliance with spectacle wear, causing profoundly low functional vision. Myopia in the 18 eyes ranged from -3.75 to -11.5 D (mean -16.6 D) and the desired refraction was approximately +1D. Correction was achieved by bilateral laser-assisted subepithelial keratectomy (ie, LASEK) performed under brief general anesthesia. Mean follow-up was 17 months (range, 6-36 months). RESULTS: Myopia correction averaged 7.9 D. Eighty-nine percent (16/18 eyes) were corrected to within +/-1 D of goal refraction. Uncorrected acuity improved postoperatively in all 18 eyes, with commensurate gains in behavior and environmental visual interaction in 88% (15/17 children). Myopic regression averaged approximately 0.8 d/year. the only complication encountered was mild (1+) corneal haze in 35% of treated eyes. DISCUSSION/CONCLUSIONS: Bilateral excimer laser surgery is effective for improving functional vision substantially in highly myopic, neurobehaviorally impaired children who have difficulties wearing glasses. Myopic regression is common. Further study is indicated to determine the long-term safety of these and alternative refractive procedures in similar pediatric populations.     

Refractive lens exchange for correction of high myopia

PURPOSE: To evaluate the efficiency and safety of refractive lens exchange for the correction of high myopia. METHODS: We made a prospective study of the results of refractive lens exchange in 72 eyes that had undergone this surgical procedure between January 1996 and January 2001. Lens extraction by phacoemulsification was done by one surgeon on 34 patients. Follow-up was five months to five years (mean 48 months). The postoperative refractive target was emmetropia or a low degree of myopia. We compared pre- and postoperative uncorrected visual acuity, and preoperative best-corrected visual acuity with postoperative uncorrected visual acuity. Intra- and postoperative complications were recorded. RESULTS: In 72.2% of the eyes best-corrected visual acuity (BCVA) was > or = 0.5 before surgery. Four years after refractive lens exchange, uncorrected visual acuity (UCVA) was > or = 0.5 in 58.3% of eyes, and the proportion of eyes with BCVA > or = 0.5 increased to 83.3%. The sphere was fully corrected in 70.8% of cases, remained within 1.0 D of emmetropia in 87.5% and within 2.0 D of emmetropia in 95.8%. Posterior capsule opacification developed in 22 eyes (30.5%) and was treated with neodymium:YAG (Nd:YAG) laser capsulotomy. Cystoid macular edema with retinal detachment occurred in one eye. No wound leakage or eye infections were observed during five years' follow-up. CONCLUSIONS: Refractive lens exchange seems to be an effective alternative for the correction of high myopia, helping people over 40 years of age regain their distant vision.     

Use of contact lenses for correction of amblyopia in high unilateral myopia in children

Persistent amblyopia in high unilateral myopia (anisometropia higher than or equal to - 3.5 diopters) has different causes: missed early diagnosis or therapeutic strategy error. With the intention of preventing the latter, we investigated the use of contact lenses. With occlusion treatment, we obtained substantial improvement of visual acuity of the amblyopic eye. Exophoric and exotropic patients retained all binocular vision and binocular union, as did most (3/4) of the microesotropic patients. This treatment has the advantages of being permanent, esthetic, and well accepted by parents.     

Refractive surgery for high bilateral myopia in children with neurobehavioral disorders: 1. Clear lens extraction and refractive lens exchange.

INTRODUCTION: A subpopulation of children with high myopia and neurobehavioral disorders is noncompliant with spectacle wear and ill-suited to correction using contact lenses. We report the results of refractive surgery in a series of these children treated using lensectomy alone (clear lens extraction), or lensectomy with simultaneous implantation of an intraocular lens (refractive lens exchange). METHODS: Clinical course and outcome data were collated prospectively in a group of 13 children (mean age 10.4 years, range 1 to 18 years) with neurobehavioral disorders exacerbated by chronic noncompliance with spectacle wear, causing profoundly low functional vision. Myopia in the 26 eyes ranged from -14.25 to -26.00 D (mean -19.1 D). Goal refraction was approximately +1 D. Correction was achieved by lensectomy alone in 10 eyes, and lensectomy with intraocular lens implantation in 16 eyes. Primary posterior capsulectomy/subtotal vitrectomy was performed during the primary procedure in 11 eyes (42%). Mean follow-up was 4.5 years (range 1.3 to 7.5 years). RESULTS: Myopia correction averaged 19.9 D. Eighty-one percent (21 eyes) were corrected to within +/-2 D of goal refraction and the remaining 19% (5 eyes) to within +/-4 D. Uncorrected acuity improved substantially (ie, an average 2 log units) in all 26 eyes, with commensurate gains in behavior and environmental visual interaction in 85% [corrected] of children (11/13) [corrected] Myopic regression averaged -0.16 D/year. Capsular regrowth and/or opacification necessitated vitrector or YAG-laser membranectomy in 13 [corrected] eyes (50%) [corrected] Focal retinal detachment (successfully repaired) occurred after eye contusion in one eye (4%) with cicatricial retinopathy of prematurity. CONCLUSIONS: Bilateral refractive lensectomy is effective for improving functional vision in neurobehaviorally impaired children who have high myopia (beyond the range of excimer laser correction: see companion publication) and difficulties wearing glasses. Posterior capsule regrowth/opacification is common, necessitating secondary membranectomy. Further study is indicated to determine the long-term safety of this procedure in similar pediatric populations.     

高度近视眼白内障手术

目的对54例74眼高度近视白内障手术进行分析,74眼眼轴均≥26mm,最长34.48mm,探讨其手术的安全性、有效性.方法囊内摘出2眼,现代囊外摘出27眼,Ⅰ期植入后房型人工晶状体45眼,手术方法同常规白内障,采用球后加面神经阻滞麻醉.结果术后视力＜0.1者5眼,0.1～0.2者26眼,0.3～0.5者20眼,0.6～0.9者19眼,≥1.0者4眼.1例2眼术后出现视网膜脱离.结论高度近视眼白内障手术安全、有效、并发症少,眼底病变及眼轴长度与术后视力关系明显,人工晶状体植入后视力明显好于非植入组.     

Optic nerve disc in unilateral myopia in children

PURPOSE: The evaluation of biomorphometric parameters of optic nerve head of the eyes in myopic anisometropia, to state if glaucoma similar changes described in adults were present. MATERIAL AND METHODS: 17 children, 14 girls and 3 boys at the age from 7-18 years, mean 12.6 years with unilateral myopia of mean value 8.6 D. The parameters of optic nerve disc: total contour area (TCA), cup/disc ratio (C/D), neuroretinal rim area (Rim), volume of neuroretinal rim (Vol. A), cup volume (Vol. B), maximum slope (MSL) and average slope angle (ASL) were examined using laser scanning ophthalmoscope in the TopSS system of Laser Diagnostic Technologies Inc. The I group consists of myopic eyes, in the II group there were emmetropic eyes of the same children. RESULTS: Refraction in the I group ranged from -4.5 to -12 D, mean -8.6 D, in the II group from 0 to + 1.0 D, mean 0.07 D. The mean axial length of eyeballs was 25.57 SD 1.9 mm in the I and 22.47 SD 1.09 mm in II group--the difference was significant. There was not statistically significant difference between TCA in the I (mean 1.19 SD 0.75 mm2) and II group (mean 2.13 SD 0.49 mm2). Mean C/D ratio and cup volume were significantly smaller in myopic (C/D 0.23 SD 0.16 Vol. B -0.06 SD 0.05) than in emmetropic eyes (C/D 0.33 SD 0.11 mm3, Vol. B -0.18 SD 0.14 mm3). CONCLUSIONS: Optic nerve disc images in myopic and glaucomatous eyes in children are different. Smaller optic disc cup in myopic than in emmetropic eyes can show, that children myopic eyeballs enlarged without nerve fibers atrophy.     

高度近视一眼白内障另一眼透明晶状体双眼手术的疗效分析

目的 分析高度近视一眼合并白内障另一眼透明晶状体双眼手术的临床效果.方法 回顾性分析我院2007年1月至2011年7月收治的68例(136眼)双眼高度近视且一眼合并白内障另一眼为透明或半透明晶状体患者的临床资料.68例患者晶状体透明或半透明的68眼作为观察组,另一合并白内障眼作为对照组,同期行白内障超声乳化联合人工晶状体植入术.术后随访6～18个月,对比分析两组患者手术后视力恢复情况、屈光状态及并发症情况.评价高度近视透明晶状体置换术的安全性.结果 观察组术后3个月最佳矫正视力为4.67±0.20,好于术前最佳矫正视力4.47 ±0.21 (P ＜0.05),安全性指数为1.04.观察组术后1周、3个月最佳矫正视力为4.64±0.22、4.67±0.20,对照组为4.58 ±0.25、4.66±0.20,两组同时间点比较差异均有统计学意义(均为P ＜0.05).观察组有86.8％(59眼)、对照组有83.8％(57眼)术后等效球镜控制在预置屈光度±1.00D范围内,两组比较差异无统计学意义(X2=0.234,P=0.628).两组术后3个月等效球镜比较差异无统计学意义(P＞0.05).观察组有5眼、对照组有17眼发生了手术并发症,两组并发症发生率相比差异有统计学意义(x2=7.810,P=0.005).68例患者均未发生交感性眼炎等并发症.结论 高度近视一眼白内障而另一眼为透明晶状体者,选择双眼同期手术能减少透明晶状体眼的并发症,消除屈光参差,早期恢复双眼单视功能,提高视觉质量.     

Refractive surgery in myopia. I. Radial keratotomy]

It is stressed that in myopia one performs 2 kinds of operation: therapeutical and for a change in refraction. Not only surgical methods but also the aim of operation are basically different. The author present the foundation, the development of the method, the up-to-date results of operation and complications connected with the radial keratotomy which is not therapeutical but refractive operation. Especially precisely are presented the qualification criteria for the surgery which are basing mainly on a--conceived on a large scale--American PERK study.     

Macular hole surgery in high myopia

PURPOSE: To evaluate the anatomic and functional outcomes of macular hole surgery in high myopia and to determine whether surgery is beneficial in myopic eyes with macular holes. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Twenty eyes of 18 highly myopic subjects who underwent pars plana vitrectomy for macular holes. METHODS: We analyzed demographics, preoperative, and postoperative characteristics in 20 eyes with macular holes with a mean of 10.4 months duration and myopia of 6 diopters or greater. MAIN OUTCOME MEASURES: Macular hole closure rate and mean visual acuity preoperatively and postoperatively. RESULTS: Mean subject age was 56.4 years and preoperative visual acuity was 20/100+2. The macular hole was closed with one surgery in 60.0% of eyes and in 85.0% of eyes with one or more surgeries. The mean final acuity in all eyes was 20/63, and 40.0% improved greater than three Snellen lines at the final visit. The use of adjunctive agents seemed to have no effect on macular hole closure or visual acuity. A subgroup of three myopic eyes with retinal detachments surrounding the macular hole had successful closure with visual acuity improvement in two of three eyes. CONCLUSIONS: Macular hole surgery can give substantial visual improvement in myopic eyes with macular holes, but the anatomic closure rates are lower than in eyes with idiopathic macular holes, and thus a higher reoperation rate is required.