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A frequent point of debate between refractive and retinal surgeons is the risk of pseudophakic retinal detachment (RD) in highly myopic eyes, defined as eyes with an axial length greater than 26 mm (sometimes even exceeding 30 mm) and usually with a spherical equivalent superior to –6.00 D. This degree of myopia is mostly associated with degenerative changes that involve sclera, choroid, retina and vitreous. Today, refractive lens exchange (RLE) is frequently proposed as a refractive surgical procedure for the correction of high myopia in presbyopic middle-aged myopes, and cataract surgery is performed at earlier ages. However, it is important to determine the risk of RD after both RLE (whether cataractous or a clear lens) and phakic intraocular lenses (whether anterior or posterior chamber) especially in highly myopic eyes. But do we have the evidence about this important issue to inform our patients and to alert ourselves to advise our patients adequately? Every ophthalmic surgeon remembers the stressing experience of a relatively young myopic patient suffering RD following an RLE. Even today and with the progress in vitreoretinal surgery, RD is not always followed by a full visual recovery, and severe visual loss is the endpoint of many patients with RD.
The risk of retinal detachment in highly myopic patients is mainly due to two possible causes: a higher incidence of predisposing retinal lesions in myopic eyes compared with the general population and the hypothesis that LE might induce several iatrogenic factors that will increase the incidence of retinal tears, especially promoting vitreous changes postoperatively.
The literature on this issue is frequently unclear. Previous studies reported a higher incidence of RD in unoperated highly myopic eyes compared with non-myopic eyes (whether emmetropic or hypermetropic).1 2 These studies reported a risk of RD ranging between 0.71% and 3.2%.1 2 Previously published reports …