Myopia surgery with an intraocular lens in severe myopia

PICHON RIVIERE, A.; AUGUSTOVSKI, F.; ALCARAZ, A.; BARDACH, A.; GARCIA MARTI, S.; LOPEZ, A.; GLUJOVSKY, D.; REGUEIRO, A.

Documentos de Evaluación de Tecnologías Sanitarias

IECS

Año: 2006 p. 1 - 30

1668-2793

The aim of this report was to assess the usefulness of intraocular lenses in severe myopia.One RCT published by Malecaze et al compared the use of LASIK with intraocular lens placement in 25 subjects with severe myopia (between 8 and 12 D). In all cases, myopia was bilateral and had no astigmatism higher than 1.5 D. Each patient was treated with LASIK in one eye and with intraocular lenses in the other. There were no significant differences in both procedures as regards visual acuity either. When considering a higher corrected visual acuity with eye glasses, intraocular lenses showed a better profile during all the stages assessed (except one month post-surgery) There were no significant complications in both groups during or post-surgery. There were no significant differences in both techniques as regards loss of corneal endothelial cells either. Another RCT published by El Danasoury et al compared both techniques in 90 eyes from 61 patients presenting myopia between -9 and -19.50 D. When comparing both groups of eyes assessed, the intraocular lens group showed better results in visual acuity without correction (20/20 or higher in 20.9% vs. 12.2%; p=0,01) and also in corrected visual acuity with glasses (20/20 in 41.9% vs.17.1%, p=0,02) after one year follow-up. There were significant differences in the quality of the vision patients experienced. As regards possible complications, one study published by the Food and Drug Administration (FDA), with a two year follow up, did not show a higher frequency of endothelial cell loss in patients treated with intraocular lenses. One study published by Edelhauser et al shows that in one analysis carried out on subgroups of patients followed up during 4 years, there was an 8.5% cumulative loss of endothelial cells approximately until the third year, this becoming stable during the fourth year (the FDA states a limit not higher than 1.5% per year). One health technology assessment carried out in 2004 by a Danish agency shows that the use of intraocular lenses in severe myopia is an alternative with very good results in vision but it involves considerable medical complications and must be used only in special cases with adequate patient counseling.