Síndrome de disfunción del cristalino y su intercambio refractivo / Lens Dysfunction Syndrome and its Refractive Exchange

La capacidad de ver bien es una preocupación para todos, especialmente a medida que se envejece. Los cambios en los ojos con el tiempo son inevitables, pero existen opciones de tratamiento para ayudar a tratar los problemas que pueden aparecer en la visión. El síndrome de disfunción del cristalino se caracteriza por englobar algunas de las alteraciones visuales más comunes relacionadas con la edad y que suelen aparecer a partir de los 40 años. La principal causa del síndrome de disfunción del cristalino es el envejecimiento natural de esta estructura ocular. Los síntomas más comunes son visión borrosa, disminución de la sensibilidad a los colores o dificultad y cambios en la visión cercana. El término es poco usado en Cuba por lo que el objetivo fue realizar una revisión sobre el síndrome de disfunción del cristalino y su intercambio refractivo. Existen diferentes opciones de tratamiento, desde gafas hasta el recambio refractivo del cristalino por una lente intraocular, que se usa cada vez a más temprana edad y que gracias al adelanto tecnológico y aumento de la pericia del médico, constituye un tratamiento eficaz en pacientes pregeriátricos(AU)

The ability to see well is a concern for everyone, especially as one ages. Changes in the eyes over time are inevitable, but there are treatment options to help address the problems that can occur in vision. The lens dysfunction syndrome is characterized as encompassing some of the most common age-related visual disorders that usually appear after the age of 40. The main cause of lens dysfunction syndrome is the natural aging of this ocular structure. The most common symptoms are blurred vision, decreased sensitivity to colors or difficulty and changes in near vision. The term is hardly ever used in Cuba, so the objective was to review the crystalline lens dysfunction syndrome and its refractive exchange. There are different treatment options, from glasses to the refractive exchange of the crystalline lens for an intraocular lens, which is used at an increasingly younger age and which, thanks to technological advances and increased medical expertise, is an effective treatment in pregeriatric patients(AU)

Clinical observation of refractive lens exchange for high myopic eye / 中华实验眼科杂志

Background Refractive lens exchange is one of corrective surgeries for high myopic eyes and is concerned in clinic recently. Its clinical value is worthy of consideration. Objective This study was to investigate the efficacy and safety of refractive lens exchange for high myopic eyes. Methods Phacoemulsification and intraocular lens implantation was performed on 124 eyes of 65 patients with high myopia. The mean age of these patients was 51. 4±8. 57 years old,and the preoperative corrected visual acuity was 4. 11±0. 51. The mean spherical equivalent was ( -20. 17±5. 34) D. The mean axial length was (31. 33±2. 08) mm and intraocular lens power 2. 88 D. The follow-up time was 31 months. The uncorrective visual acuity, best corrective visual acuity, the spherical equivalent lens and complications were observed after operation. Written informed consent was obtained prior to the surgery. Results The uncorrective visual acuity improved after the operation in all the eyes. The uncorrective visual acuity was ≥0.5 in 15 eyes(12% ). The best corrected visual acuity improved in 114 eyes (92% ) following the surgery and that of 64 eyes (51. 6% ) was 2s 0. 5. The mean postoperative spherical equivalent was ( -2. 57 ± 1. 76 ) D in the entire follow-up duration. Posterior capsular opacification was found in 58 eyes (46. 7% ) and received laser capsulotomy. Retinal detachment occurred in 4 eyes throughout the follow-up period. Conclusion Refractive lens exchange is an effective and safe method for high myopic eyes. But preoperative fundus examination and long-term postoperative follow-up should be carried out to prevent the complications.

Surgical Correction of Hyperopia

Surgical modalities to correct hyperopia include photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), Ho:YAG laser thermal keratoplasty (LTK), conductive keratoplasty (CK), phakic IOL, and refractive lens exchange. Excimer laser-based techniques, which include LASIK, LASEK, and PRK, are currently the most popular forms of surgery to correct not only myopia and astigmatism but also hyperopia. These techniques have been reported to be safe and effective for both primary surgeries and enhancements. However, various complications related to the flap and loss of best corrected visual acuity associated with a smaller optic zone, decentration, and irregular ablation caused by longer treatment time in high hyperopia over +5 diopter can have adverse effects on visual outcomes. The development of non-excimer laser-based techniques offers viable alternatives for laser vision correction techniques. More recent non-excimer-based thermal refractive techniques include LTK and CK. Earlier forms of thermal techniques showed a lack of predictability and stability, resulting in no further development of them. Recently, CK, a laserless, radiofrequency-based technique, has been approved by the FDA for the correction of low to moderate hyperopia even though the refractive instability has not been solved yet. In high hyperopia, lens approach like phakic IOL or refractive lens exchange instead of corneal surgery is preferred. ICL (Implantable contact lens) and Artisan is the most popular lens model that has well proven clinical results concerning its safety and effectiveness. Accommodative IOL or multifocal IOL could be the solution for pseudophakic presbyopia in refractive lens exchange in the future.