PURPOSE: To evaluate the application of refractive lens exchange (RLE) for middle and old age people with high myopia in security, effectivity, stability and minimum injury.
METHODS: Eighty myopic eyes of 47 patients treated with the natural crystalline lens extraction and an aphakic IOL implantation were followed, in which corneal astigmatism ≥-1.5D eyes were treated combining astigmatic keratotomy (AK) with RLE. The average age of patients was（53.71±7.26）years, the average myopia diopter was (-20.78±5.18) D, and the best corrected visual acuity (BCVA) was (0.05 ~ 0.9) (Decimal). The average follow-up time was 12 months. All the treated eyes were observed for anterior segment changes, BCVA, optic axis length, position of IOL, intraocular pressure (IOP), manifest refraction, founds and complications.
RESULTS: Compared with preoperative data, spherical equivalent (SE) and BCVA were improved significantly after surgery. At 12 months postoperatively, none lost visual acuity. 65% of eyes in BCVA was more than 0.5. The average of predicted refractive error was（-0.23±1.03）D ( -2.25D~ +2.54D) and the absolute error was 18 eyes (33.96%) within ±0.5D, 16 eyes (30.19%) within ±0.5D~±1.0D, 12 eyes (22.64%) within ±1.0D~±1.5D and 7 eyes (13.21%) more than ±1.5D. There were correlations between axial length and predicted error or IOL power and predicted error, though the coefficient was not big. Corneal astigmatism with a Vector- based method was applied in the groups of RLE with AK. Actual corrected quantity of surgery was（1.72±0.93）D and the angle of axial between effective surgery and preoperative was（5.1±3.1）D. Postcapsular rupture occurred in one eye during surgery. Macular hemorrhage in 1 eye and posterior capsule opacification ( PCO) in 1 eye were found during the follow-up and no patients complicated other complications such as halo, glare et al.
CONCLUSIONS: RLE is effective and safe for treatment of middle and old people with high myopia and the results are predictable, which can improve patients’ quality of life. The further effectiveness or application in other ametropia patients of this kind of surgery should be further observed.
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