Clear Lensectomy and Intraocular Lens Implantation in Normally Sighted Highly Hyperopic Eyes. Three-year Follow-up

Objective: To present the results, complications and management of a series of 17 normally sighted eyes who have undergone clear lens extraction and IOL implantation for the correction of high hyperopia. The follow-up period was 1 to 3 years (mean: 26.2 months). Main Outcome Measures: Unaided visual acuity, predictability, endothelial cell loss percentage, complications and management. Method: Extracapsular clear lens extraction and posterior chamber IOL implantation was performed in 17 normally sighted eyes of 9 patients, 35 to 55 years old (median 45), with a hyperopic spherical equivalent of + 9.61 ± 0.46 D (range: + 6.75 to + 13.75 D). The axial length range was 17.88 to 22.78 mm. Refraction was aimed at -1.50 to account for the inaccuracy of the SRK II formula in high hyperopic eyes. Results: One case had an uneventful intraoperative posterior capsular tear. Mean unaided visual acuity improved from CF to 0.84 (range: 0.7–1.0) at 3 years. Postoperative correction ranged from −0.87 to + 0.50 D at 1 year and −0.25 to + 0.62 at 3 years. The mean endothelial cell loss percentage at 3 years was 11.2% ± 0.59 (range: 8–13%). Three eyes developed posterior capsular opacification at 20 and 21 months and were uneventfully treated with Nd:YAG laser capsulotomy. Conclusion: The incoming excellent results in accuracy, safety and rapid stability of refraction with longer follow-up show that clear lens extraction and IOL implantation is advantageous over other refractive procedures in high hyperopia. Aiming at −1.50 DS with SRK II formula in highly hyperopic eye with an axial length of 17.88 to 22.78 mm, results in a correction near to emmetropia.