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Management of cataract surgery in a high myope
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  1. Richard Packard, consultant ophthalmologist
  1. Windsor Hospital, Surrey, UK

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    Helen Seward, Richard Packard, David Allen

       Management problem

    A 52 year old high myope presents with misty vision as a result of cataracts. With his contact lenses he sees 6/9 part right eye, 6/9 left eye and reads N8 right eye, N6 left eye with glasses.

    He is wearing −12.00/−2.00 × 75 right eye, −11.00/−1.00 × 90 left eye. He has bilateral posterior subcapsular plaques R > L and myopic retinal degeneration. Axial lengths measured using SRK-T are 30.60 mm right eye, 30.31 mm left eye.

    He is a keen runner and would like good unaided distance vision post-surgery. He is very light sensitive and finds tonometry difficult.

    How would you manage this patient's cataract surgery, in particular the type of anaesthetic, the surgical management plan, and the choice of intraocular lens?

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      This patient, who is highly myopic presents with reasonably good distance vision but compromised reading. However, we may assume that his distance VA in glare conditions will be much worse because of his posterior subcapsular plaques and that it is from this that his problems really arise. He has also expressed a desire for good unaided distance vision post-surgery which will require some form of correction for his astigmatism.

    Preoperative assessment

    As part of the preoperative assessment the following tests should be carried out to assist in developing the appropriate surgical plan.

    (1)

    Full fundal examination has shown myopic degeneration. Assess these lesions in the retina as they may require treatment either before or immediately after the surgery.

    (2)

    Ultrasonic A-scan using the appropriate formula and A-constant. As used here SRK-T is accurate for high myopes. As an alternative the Holladay II may be used, which requires the white to white corneal measurement. When doing the A scan be aware that high myopes may have posterior polar …

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