Comparative analysis of the effectiveness of various methods of intraocular correction in refractive lens exchange in patients with high myopia

Abstract

Objective. To conduct a comparative analysis of the clinical and functional outcomes and safety profile of refractive lensectomy in patients with high myopia following implantation of one or two IOLs. Material and Methods. This prospective study included 93 patients (177 eyes) with high myopia (greater than 6.0 diopters) and a through-axis increase in the anterior-posterior axis (APA>26 mm). Patients were divided into two groups: Control group (1-IOL): 87 eyes (46 patients) — standard single IOL implantation; Main group (2-IOL): 90 eyes (47 patients)— tandem implantation of two IOLs. The following parameters were assessed during the pre- and postoperative periods: SE, cylindrical component, BCVA, UCVA (distance and near), anterior chamber depth, as well as the incidence of capsular bag fibrosis and interlens opacification. Optical biometry and anterior OCT were used, and IOL power was calculated using the Barrett Universal II formula. ZEISS Lucia 621 and Lucia 601 hydrophobic acrylic monofocal lenses with a heparin-coated surface were used as implants. Results. Baseline biometric and refractive parameters were comparable between the groups, with the exception of baseline astigmatism: –3.10±0.25 D in the Group 1-IOL group vs –1.79±0.31 D in the Group 2-IOL group (p=0.001). In the postoperative period, the mean residual spherical refraction was –1.00±0.10 D in the main group and –1.29±0.11 D in the control group (p<0.05). The UCVA of the dominant eye in the 2-IOL group was significantly higher than that of the control group: 0.51±0.07 and 0.44±0.06, respectively (p<0.05). No statistically significant intergroup differences were observed for the UCVA. The mean anterior chamber depth was 5.97±0.14 mm with tandem implantation and 5.52±0.12 mm with standard implantation (p<0.05). Conclusions. Refractive lensectomy with tandem implantation of two IOLs in patients with high myopia demonstrates greater predictability of the refractive outcome and provides better BCC parameters compared with traditional single-IOL implantation. At the same time, this technique maintains a similar safety profile; the use of heparin-coated IOLs potentially reduces the risk of inducing interlens opacification.