Clear-Lens Extraction for High Myopia

THE EXCELLENT article by Barraquer and coworkers on retinal detachment following clear-lens extraction in patients with myopia raises the important issue of appropriate thresholds of safety and efficacy for elective intraocular surgery and also helps to define the risk factors for and time course of retinal detachment following extracapsular lens (or cataract) extraction. The literature on retinal detachment following extracapsular surgery, either for a clear or cataractous lens, has focused on three possible risk factors: younger patient age, longer axial length, and the possible role of subsequent posterior capsulotomy. In general, the probability of retinal detachment following modern extracapsular cataract extraction has been reported as 1% or less. In this series 1 of 165 eyes of 107 patients with pathologic myopia, 12 eyes (7.27%) developed retinal detachment, with 75% of detachments occurring 18 months or more after surgery. Patients under the age of 30 years had 2.5 times greater odds