Two Cases of Treatment of Extreme Myopia using combined Anterior Chamber Phakic Intraocular Lens and Laser In Situ Keratomileusis

PURPOSE: For patient with extreme myopia outside the suspected limit of single procedure alone, we performed Lasik as a secondary procedure for the correction of residual refractive error following phakic IOL implantation. METHODS: First, we made a corneal flap using ACS(Bauch & Lomb surgical/Chirom vision, Irvine, CA) due to the potential risk of endothelial damage by cornea-IOL contact during the flap dissection. One month later, phakic IOLs, Nuvita MA20 (Bauch & Lomb surgical/Chiron vision, Irvine, CA) implantation were done, and 4 months after IOL implantation, stromal ablation was performed with the eximer laser by using previously formed flap. RESULTS: Preoperative spherical equivalent refraction was -25.0 D of Rt eye, -24.0 D of Lt eye, and preoperative visual acuity was 20/500 (best spectacle corrected visual acuity; BSCVA: 20/50) of Rt eye, 20/200 (BSCVA: 20/40) of Lt eye. Spherical equivalent refraction following phakic IOL implantation was -4.25 D of Rt eye, -3.75 D of Lt eye and refractive cylinder was -1.0 D cyl x90 A, visual acuity was 20/100 (BSCVA: 20/40) of Rt eye, 20/100 (BSCVA: 20/40) of Lt eye. Spherical equivalent refraction at the last examination following LASIK was -0.75 D of Rt eye, -0.5 D of Lt eye and visual acuity was 20/25 (BSCVA: 20/25) of Rt eye, 20/25 (BSCVA: 20/25) of Lt eye. CONCLUSIONS: Bioptics by combined anterior chamber phakic intraocular lens and laser in situ keratomileusis is one of the effective methods for patients with refractive error of extreme myopia outside the suspected limits of single procedure alone. Longer follow-up of large number of cases is needed to fully assess the safety and complications.

Results of Nuvita Phakic Anterior Chamber Intraocular Lens for High Myopia

PURPOSE: The study was designed to evaluate the clinical results of an anterior chamber intraocular lens implantation (Nuvita MA 20 implantation) on high myopic patients. METHODS: We reviewed the clinical results of Nuvita MA 20 implantation surgery in 6 high myopic patients (11 eyes) with more than -7.0 diopters (D) for a year after the surgery. One patient was male,five patients were female and the mean age was 31.5 years old (25~41 years old). RESULTS: Mean preoperative spherical equivalent was -16.61 4.9 D and mean postoperative spherical equivalent was -0.9+/-0.5 D at 1 week, -1.275+/-1.14 D at 1 month, -1.14+/-1.22 D at 3 months, -1.18+/-1.18 D at 6 months and -1.05+/-1.2 D at 12 months. Mean uncorrected visual acuity preoperatively was 0.03+/-0.06 and postoperatively was 0.6+/-0.25 at 1 week, 0.57+/-0.25 at 1 month, 0.67+/-0.4 at 6 months, 0.8+/-0.32 at 12 months. Postoperative complications included 6 eyes of IOL rotation (55%), 4 eyes of pupil distortion (36%), 1 eye of intraocular pressure elevation (9%), 1 eye of pupillary block (9%), 1 eye of IOL decentration (9%) and 1 eye of nuclear cataract (9%), but serious postoperative complications such as retinal detachment and bullous keratopathy were not found. Mean endothelial cell density was 2677+/-148 (cells/mm2) at preoperative period, 2576+/-167 (cells/mm2) at 1 month, 2546+/-127 (cells/mm2) at 3 months, 2490+/-171 (cells/mm2) at 6 months and 2408+/-133 (cells/mm2) at 12 months. CONCLUSIONS: The implantation of Nuvita MA 20 into anterior chamber is considered to be a safe method of treatment for patients with high myopia.