Cataract surgery in high myopes: Qinghai Aier Eyes Hospital in China

Introduction: Cataract surgery is currently refractive surgery of the lens, also for elderly patients; however, in patients with high myopia, it is always going to constitute a risk and depends on many factors to achieve a therapeutic and refractive surgical success. Methods: A retrospective longitudinal cohort study was performed on patients operated for senile cataract with high myopia in the cataract service of Aier Eyes Hospital in Xining, Qinghai, China, over a period of 1 year. A total of 594 patients were selected through a systematic randomized selection, after applying inclusion and exclusion criteria (790 operated eyes in total, 196 bilateral and 398 unilateral). Baseline characteristics were summarized (number and proportions for qualitative variables; mean and standard deviation for continuous variables). Statistical significance was considered when P ≤ 0.005. Results: The mean age of the patients was 72.5 years, and 321 (54.9%) were male. A total of 790 eyes were operated: unilateral (50.3%) and bilateral (24.8%). Nuclear cataract predominated in 725 eyes (91.7%), P ≤ 0.005. The mean axial length was 28.697 mm, with a range of deviation from 27.05 to 34.19 mm, which was statistically significant P = 0.003. Preoperative UVA was MH and finger counting in 71.5% and 20/100 in 161 patients (27.2%). After surgery, 69.8% of the patients reached 20/25 with correction ( P = 0.003) and 54.7% without correction. Preoperative spherical equivalent (SE) was −15.50 D, with a range of −6.00 D to −27.25 D (±6.99 D). The preoperative spherical equivalent was -15.50 D, with a range of -6.00 D to -27.25 D. The estimated postoperative spherical equivalent was -0.50 D (±1.1002 D) and the achieved spherical equivalent was -0.75 D (±1.1002 D) in 504 patients, representing 84.8% for a P ≤0.005. Eighty-seven patients were in the range of -1.25 to -2.00 D, representing 14.6%. The power of the IOL was 4.07 ± 3.75. A total of 228 eyes with zonular weakness were implanted with capsular tension ring (CTR) out of 790 (28.8%). The IOL model implanted was CT Asphina, a monofocal hydrophobic lens. Posterior capsule opacity (PCO) was the most relevant complication at 1 year of the study in 198 eyes of the 562 that did not have CTR (35.2%); only 4 eyes of the 228 that had CTA implanted developed PCO at 1 year of the study (1.75%). Conclusions: Cataract surgery in elderly patients with high myopia is a challenge due to the anatomical characteristics of the eyeball; however, it is possible to achieve good postoperative visual acuity with and without correction, better postoperative SE, and to implant an IOL according to the patient’s requirements, as well as to insert a CTA and reduce the number of complications that may occur. Cataract surgery in eyes with high myopia will always constitute a risk, so we must be careful when approaching the previous state of an eye with high myopia and senile cataract, since the final refractive result will not only depend on the surgeon’s expertise but also on the biometric measurements of the eye that can be as accurate as possible, the calculation of the power of the IOL, the effective position of the crystalline lens, and the future complications that may arise.