Efficacy of Large Optic Intraocular Lenses in Myopic Eyes with Posterior Segment Pathology

Abstract

We report a case series of patients with high myopia (axial length 25.04-27.59 mm) diagnosed with cataract and maculopathy who underwent a combined procedure of phacoemulsification with implantation of a large optic intraocular lens (IOL) and intravitreal injection. Six patients with a mean (± standard deviation) age of 73.20 ± 7.19 years received the 7.0-mm optic ASPIRA-aXA IOL (HumanOptics AG, Erlangen, Germany) and intravitreal injection of aflibercept at the end of the surgery. The corrected distance visual acuity (CDVA) improved significantly (p = 0.001) from a preoperative logMAR of 0.87 ± 0.28 logMAR to 0.49 ± 0.18 logMAR at 10 weeks postoperatively. Even though all patients had a persisting central scotoma due to their maculopathy, there was a significant improvement in their subjective quality of life and self-autonomy. Patients reported no postoperative dysphotopsia. During surgery and postoperative examinations, the wide IOL optic permitted an enhanced view of the fundus. The IOLs remained stable after implantation, especially during the intravitreal injection at the end of the surgery. No IOL displacement or shift of the lens was observed. Retinal diseases are sight-threatening and diminish the patient's quality of life due to reduced visual acuity and visual field defects. When cataract surgery is performed in this patient group, a reduced prognosis can be assumed. Our results show that implantation of the large optic IOL enables a wide view of the fundus during and after surgery without any additional risks or negative effects. It may also reduce the risk of dysphotopsia in cases of IOL decentration in large capsular bags, but comparative studies with a higher number of cases are needed to confirm this. A large rhexis and large IOL optic seem to be advantageous for the retinal surgeon in follow-up surgeries on the posterior segment of the eye.

Keywords: Cataract surgery; Large optic IOL; Posterior segment pathology.

Fig. 1

Specifications of the Aspira-aXA intraocular lense with cut-out haptics and 360° sharp edge (HumanOptics AG)

Fig. 2

Schematic drawings of a 6.0-mm intraocular lens (IOL) and 5.5-mm capsulorhexis (a) and of a 7.0-mm IOL and 6.5 mm rhexis (b)

Fig. 3

Comparison of the intraoperative view with a 6.0-mm IOL (a) and a 7.0-mm IOL (b). Note the shadow of the optic rim of the 6-mm IOL

Fig. 4

Intraoperative view with the implanted 7.0-mm IOL, showing the diameters of the rhexis and IOL optic, and differences to the standard-sized IOL