Phakic intraocular lens implantation versus clear lens extraction in highly myopic eyes of 30- to 50-year-old patients.

PURPOSE: To compare the outcome of treatment for myopia by phakic intraocular lens (IOL) implantation or by clear lens extraction (CLE).

SETTING: Service d'Ophtalmologie, Hopital Purpan, Toulouse, France.

METHODS: Thirty-nine patients from 32 to 49 years of age were studied. Forty-one eyes of 21 patients received a phakic IOL, and 36 eyes of 18 patients had phacoemulsification of the crystalline lens. The mean preoperative spherical equivalent (SE) was -13.6 diopters (D) +/- 3.0 (SD) in the phakic IOL group and -16.7 +/- 3.8 D in the CLE group.

RESULTS: Postoperatively, the mean SE was -1.06 +/- 0.78 D in the IOL group and -1.88 +/- 0.83 D in the CLE group. At 12 months, the best corrected visual acuity (BCVA) had improved in 78.0% of eyes in the IOL group and 83.3% in the CLE group; no eye lost 1 line of BCVA. In 3 eyes (7.31%) in the IOL group, opacification of the crystalline lens developed 34, 36, and 44 months after implantation. Visual recovery after phacoemulsification was excellent. No eye in this group lost 1 or more lines of BCVA between 1 and 4 years of the initial surgery. In the CLE group, a retinal detachment occurred in 2 eyes at 39 and 43 months. The final BCVA in these eyes was counting fingers and 20/200.

CONCLUSION: Implantation of a phakic IOL in a highly myopic eye of a patient between 30 and 50 years of age can be considered an adequate technique with a lower risk for loss of BCVA than CLE.