High incidence of cataract formation after implantation of a silicone posterior chamber lens in phakic, highly myopic eyes

Objective: To assess the effectiveness and safety of implantation of a negative, silicone, posterior chamber intraocular lens (IOL) in the ciliary sulcus of phakic, highly myopic eyes. Design: Noncomparative consecutive interventional series. Participants: Eighteen eyes of 10 patients suffering from high-degree myopia (spherical equivalent < -10 diopters) undergoing implantation of a Fyodorov 094M-1 IOL by the same surgeon (P.H.B.) were evaluated. Intervention: A standard surgical technique was used in all patients under peribulbar anesthesia. The IOL was implanted in the ciliary sulcus immediately in front of the natural lens under protection of a viscoelastic substance (Healon) through a 3.5-mm temporal or nasal clear- corneal tunnel. No sutures were necessary in any case. A peripheral iridectomy was performed intraoperatively in 14 eyes, whereas 4 additional eyes received a yttrium-aluminum-garnet peripheral iridectomy after surgery. At the end of surgery, gentamicin and dexamethasone were given both topically and subconjunctivally. Main Outcome Measures: Visual acuity and refraction were measured before surgery, as well as 1 day, 3 months, 6 months, and 2 years after surgery. Postoperative complications were recorded. Results: Best-corrected visual acuity remained unchanged (1 eye) or improved (6 eyes by 1,5 eyes by 2, and 2 eyes by 3 Snellen lines, respectively) in 14 of 17 eyes, whereas 3 eyes experienced a decrease in best-corrected visual acuity by 1 Snellen line. Postoperative refraction approached the desired slight undercorrection at all times of examination. Cataract formation of the anterior subcapsular (8 eyes) or nuclear (only 1 eye) type was observed in overall 9 (52.9%) of 17 eyes. When considering only the patients with a follow-up of 2 years, the incidence of cataract formation was 81.9% (9 of 11 eyes). Conclusions: The high incidence of cataract formation should discourage the implantation of the type of IOL used in this study in phakic eyes to correct high-degree myopia.