The Role of Multifocal Intraocular Lens Implantation in Extreme Axial Myopia: A Case Report and Literature Review

Abstract

The prevalence of high myopia is rising globally. In addition to an increased risk of retinal detachment, high myopia is associated with earlier cataract formation. Patients with myopia are also often more motivated to become spectacle-independent after a lens procedure. However, the use of multifocal intraocular lens (MfIOL) remains controversial for patients with extreme myopia, which is classified as patients with an axial length >28 mm. Here, we present the case of a 64-year-old patient with visually significant cataract and extreme axial myopia >31 mm in both eyes who desired to be spectacle-independent. A preoperative workup revealed a normal macula with peripheral lattice degeneration. On optical coherence tomography, the macula had a normal fovea contour without the presence of a staphyloma. A thorough peripheral examination was performed by a retina specialist which required no prophylactic treatment. Pentacam analysis demonstrated a low spherical aberration and minimal ectasia risk. Cataract surgery was uneventful with a 5 mm laser capsulotomy centered over the visual axis with the placement of a trifocal intraocular lens. Two months after the cataract surgery, the remaining refractive error was corrected with a laser-assisted in situ keratomileusis enhancement. The patient achieved an uncorrected distance visual acuity of 20/15-and uncorrected near visual acuity of J1+ in both eyes. Overall, this case report and review aims to highlight important preoperative, intraoperative, and postoperative techniques to improve patient outcomes with MfIOL in patients with extreme myopia.

Effectivity and safety of trifocal intraocular lenses and capsular tension rings implantation for cataract patients with axial high myopia

“…From pseudophakic monovision to bifocal IOLs, and then to rotational asymmetric IOLs, upgraded IOLs were constantly apply for cataract patients with high myopia to achieve vision with a range of distances [8,[20][21] , but the results were not satisfactory. In recent years, a few doctors started trying to implant trifocal IOLs into highly myopic eyes, even with AL of >30 mm or patients with nasal-inferior staphyloma [22][23][24] . The researches showed that trifocal IOLs can achieve better predicted vision for cataract patients with high myopia, however, there are still some problems in previous studies.…”