Myopia and Cataract Abdulrahman Al-Muammar Grand round Sep 12/2011 1myopia and catract.

myopia and catract 1

Myopia and Cataract

Abdulrahman Al-MuammarGrand roundSep 12/2011


Outline

• Prevalence of myopia• Association between cataract and myopia• Clinical characteristics and outcomes of

cataract surgery in high myopic patients• High myopia as a risk factor for retinal

detachment after cataract extraction


Myopia

• Myopia can be– Axial

• Non-syndromic – Congenital– School– Adult

• Syndromic

– Refractive• Cataract• Corneal

4

Prevalence of myopia

– Multiple studies have found an increase in the prevalence of myopia

• In USA: between 1971-1971 and 1999-2004. Significant increase from 24% to 41.6% in rates of myopia in both men and women cohorts between the ages of 12 and 54

– Vitale et al. Arch Ophthalmol 2009

• In Israel: between 1990 and 2002. Significant increase from 20.03% to 28.3% in 16 to 22-year age group

Dayan et al. Invest Ophthalmol Vis Sci 2005• 60% to 80% in the East Saw SM. Clin Exp Optom 2003

myopia and catract

cos

most prominanat in subgroup with mild myopiaMild myopia may be associated with envirmometal factor while high myopia may be more influence by a genetic predisposition

cos

The increase was significant for mild and moderate myopiaFor high myopia there was an increase but was not significant

Abdulrahman

difficulty with all studies measuring prevalence are1- lack of one definition2- lack of cycloplegic refraction in young people3- confounding factors were not examined4-axial length and corneal curvature was not measured5-longitudinal follow up is poor6-sample size is insufficent


Prevalence of myopia

www.rightdiagnosis.com/m/myopia/stats/country– In USA , 1 in 3 or 25.74% or 70 millions– An attempt to extrapolate the above prevalence

rate for myopia to the populations of various countries and regions

– Saudi Arabia: 6,638,660 in 25,795,938

http://www.rightdiagnosis.com/m/myopia/stats/country


Consequences of myopia

• It is not only a refractive error that requires optical correction• Myopia is an important public health problem because of its

frequency and the social, education, and economic consequences

• In USA, the cost of correcting refractive errors with spectacles or contact lenses is estimated to be 2 billion dollars per year

• It is an ocular state that is associated with an increased risk of sight threatening conditions, such as cataract, myopic macular degeneration, retinal detachment, macular hole, choroidal neovascular membrane, and glaucoma


Risk factors for myopia• Causes of myopia are unclear and multifactorial

– Genetic– Ethnicity– Gender– Environmental

• Near work• Years of education• Intelligence score• Premature and low birth weight

• Unconvincing evidence– Urbanization– Height– Personality traits– Socioeconomic status– Ambient lighting– Malnutrition

cos

Dayan found positive correlation between higher level of education and prevalence of myopiacandidates with > 12 years of education had almost twice the risk of having myopia than candidates <12 years of educationPrevalence of myopia in medical students in Norway is 54.1%while in rural indian population 2.8%

cos

Prevalence of myopia among greek female studetns was found to be 46% whereas among male studetns it was only 29.7% Rosner et al. Metab Pediatr syst Ophthalmol 1991Among Israeli female 32.7 and israeli male 25.5 Dayan IOVS 2005among american it was 45.8% in female and 37.4% in male Vitale et al Arch Ophthalmol 2009

cos

the charactristic feature of the past 10 years is the expanding use of computer for amny purposes

cos

Earlier studies showed that africam american have lower prevalence of myopia than white people 1971 black was 13% and 2004 33% 1971 white was 26.3% and 2004 43still higher among white than africana merican vitale Arch Ophthalmol 2009Asian studies Showed prevalence of 60 to 80%

Abdulrahman

difficult to measure and no consistency among studiesakso difficukties come ffrom studies compared people with different educational level and socioeconomic statusPossibke theories include:- the growing eye of a child is sensitive to visual cues that could determine axial length eg if the image keeps falling behind the retina there is tendency for the eye to grow longer to out the image on the retina and this will trigger myopia- the other possibility is the increased in pressure in the posterior part of the eye during accommodation which is poorly resisted by the sclera, resulting in increased ocular length

Abdulrahman

Supported by the strong association between positive family histroy and myopiathere is a greater prevalence of myopia in children of myopic parents than in children of nonmyopic paretnsGenetic studies of myopia have been mainly twin studies, pedigree studies, and studies of familial correlationIt is hard to seperate hereditary factors from enviromental factorsRole of hereditary is more significant for higher degree of myopiaNumerous studies have shown a higher rate of myopia in children with myopic parents and an even higher risk for children with two myopic parentsIn 2008 Ros 3.3e et al. children of chinese ethnicity in singapour 29% and in sydney 3.3% Mode of inheritance and the genetic marker are not determined yetGenetic factors cant explain the recent incease in the prevalence of myopia since the genetic pool is the same

Abdulrahman

myopic individuals may be more - introverte - reflecctive - self-confident - dominant sedentary

Abdulrahman

several studies have shown that myopic individuals are taller than myopic individual. However, this difference is often explained by a difference in socioeconomic status

Abdulrahman

earlier studies among african tribal and lebanese arab infants showed that malnurished individuals had higher myopia rates.recently people diet is improving especially in asia but myopic rate is increasingin 2010 Lim et al. evaluated the association between myopia, axial lenght, and dietary factors of 851 chinenese children using food frequencies. after the authors controlled for age, gender, body mass index, socioeconomic status, parental education, time spent outdoors abd books read per week, they found that higher saturated fat and cholestrol were correlated with longer axial lenght Lim LS et al. Ophthalmology 2010

Abdulrahman

there are many studies supporting the association between near work and myopia.- the most common type of myopia is school myopia which start at age of 7 and conti till late teens early twenties-Orevalenc eo g myopia higher in certain jobs such as microscopy, sewing, carpet weaving, -higher prevalence of myopia among college students-higher number of new cases in the college years-higher incidence of myopia among US graduates after they studied chinese in universities

Abdulrahman

Several studies from USA, finland, and Israel, and denmark have shown a higher prevalence of myopia among individual with higher educational level

Abdulrahman

Refractive error and intelligance have been compared in various studies with inconsistent resultsIt is hypothesized that ocular axial length is directly related had significantlyto cerebral development. It is also been speculted that similar genes influence both IQ and myopiaIn singapour after controlling for age, gender,parental myopia, education and books read per week, children with higher IQ scores had significantly more myopia than those with lower IQ scores

Abdulrahman

In 2003 A MULTI CENTRE STUDY REPORTED SIGNIFICANT different prevalence rates among children of four differenr ethnic groups. Thenhighest rate was asian children 18.5%, hispanic 13.2%, african 6.6%, caucasian 4.4% Kleinstein RN et al. Arch Ophthalmol 2003Rose et al 2008. study done on chinese children done in sigapore and syney found prevalence in singapore is 29% and in sydney is 3.3%

Abdulrahman

Many studies have shown an association betweeen increased myopia in urban areas as compared to rural areas are confounded by variables such as level of education, IQ, socioeconomic status, near related activities and outdoor exposure.

Abdulrahman

there is currently no consensus on whether ambient nighttime lighting during early childhood is a true risk factor for myopic development

Abdulrahman

It geenrally accepted that the mechanism leading to chnages in ocular elongation involves local retinal image processing which sends a stop or go message to the sclera, regulating scleral matrix propeerties and its rate of elongation


A A

A

A

A

A

Near

Near

Distant


A A

A A


Risk factors for myopia• Causes of myopia are unclear and multifactorial

– Genetic– Ethnicity– Gender– Environmental

• Near work• Years of education• Intelligence score• Premature and low birth weight

• Unconvincing evidence– Urbanization– Height– Personality traits– Socioeconomic status– Ambient lighting– Malnutrition

cos

Dayan found positive correlation between higher level of education and prevalence of myopiacandidates with > 12 years of education had almost twice the risk of having myopia than candidates <12 years of educationPrevalence of myopia in medical students in Norway is 54.1%while in rural indian population 2.8%

cos

Prevalence of myopia among greek female studetns was found to be 46% whereas among male studetns it was only 29.7% Rosner et al. Metab Pediatr syst Ophthalmol 1991Among Israeli female 32.7 and israeli male 25.5 Dayan IOVS 2005among american it was 45.8% in female and 37.4% in male Vitale et al Arch Ophthalmol 2009

cos

the charactristic feature of the past 10 years is the expanding use of computer for amny purposes

cos

Earlier studies showed that africam american have lower prevalence of myopia than white people 1971 black was 13% and 2004 33% 1971 white was 26.3% and 2004 43still higher among white than africana merican vitale Arch Ophthalmol 2009Asian studies Showed prevalence of 60 to 80%

Abdulrahman

difficult to measure and no consistency among studiesakso difficukties come ffrom studies compared people with different educational level and socioeconomic statusPossibke theories include:- the growing eye of a child is sensitive to visual cues that could determine axial length eg if the image keeps falling behind the retina there is tendency for the eye to grow longer to out the image on the retina and this will trigger myopia- the other possibility is the increased in pressure in the posterior part of the eye during accommodation which is poorly resisted by the sclera, resulting in increased ocular length

Abdulrahman

Supported by the strong association between positive family histroy and myopiathere is a greater prevalence of myopia in children of myopic parents than in children of nonmyopic paretnsGenetic studies of myopia have been mainly twin studies, pedigree studies, and studies of familial correlationIt is hard to seperate hereditary factors from enviromental factorsRole of hereditary is more significant for higher degree of myopiaNumerous studies have shown a higher rate of myopia in children with myopic parents and an even higher risk for children with two myopic parentsIn 2008 Ros 3.3e et al. children of chinese ethnicity in singapour 29% and in sydney 3.3% Mode of inheritance and the genetic marker are not determined yetGenetic factors cant explain the recent incease in the prevalence of myopia since the genetic pool is the same

Abdulrahman

myopic individuals may be more - introverte - reflecctive - self-confident - dominant sedentary

Abdulrahman

several studies have shown that myopic individuals are taller than myopic individual. However, this difference is often explained by a difference in socioeconomic status

Abdulrahman

earlier studies among african tribal and lebanese arab infants showed that malnurished individuals had higher myopia rates.recently people diet is improving especially in asia but myopic rate is increasingin 2010 Lim et al. evaluated the association between myopia, axial lenght, and dietary factors of 851 chinenese children using food frequencies. after the authors controlled for age, gender, body mass index, socioeconomic status, parental education, time spent outdoors abd books read per week, they found that higher saturated fat and cholestrol were correlated with longer axial lenght Lim LS et al. Ophthalmology 2010

Abdulrahman

there are many studies supporting the association between near work and myopia.- the most common type of myopia is school myopia which start at age of 7 and conti till late teens early twenties-Orevalenc eo g myopia higher in certain jobs such as microscopy, sewing, carpet weaving, -higher prevalence of myopia among college students-higher number of new cases in the college years-higher incidence of myopia among US graduates after they studied chinese in universities

Abdulrahman

Several studies from USA, finland, and Israel, and denmark have shown a higher prevalence of myopia among individual with higher educational level

Abdulrahman

Refractive error and intelligance have been compared in various studies with inconsistent resultsIt is hypothesized that ocular axial length is directly related had significantlyto cerebral development. It is also been speculted that similar genes influence both IQ and myopiaIn singapour after controlling for age, gender,parental myopia, education and books read per week, children with higher IQ scores had significantly more myopia than those with lower IQ scores

Abdulrahman

In 2003 A MULTI CENTRE STUDY REPORTED SIGNIFICANT different prevalence rates among children of four differenr ethnic groups. Thenhighest rate was asian children 18.5%, hispanic 13.2%, african 6.6%, caucasian 4.4% Kleinstein RN et al. Arch Ophthalmol 2003Rose et al 2008. study done on chinese children done in sigapore and syney found prevalence in singapore is 29% and in sydney is 3.3%

Abdulrahman

Many studies have shown an association betweeen increased myopia in urban areas as compared to rural areas are confounded by variables such as level of education, IQ, socioeconomic status, near related activities and outdoor exposure.

Abdulrahman

there is currently no consensus on whether ambient nighttime lighting during early childhood is a true risk factor for myopic development

Abdulrahman

It geenrally accepted that the mechanism leading to chnages in ocular elongation involves local retinal image processing which sends a stop or go message to the sclera, regulating scleral matrix propeerties and its rate of elongation


Preventive measures in myopia

– Eliminating near work • Refractive

– Bifocal spectacles

• Pharmacological– Atropine– Pirenzepine

– Overnight hard contact lenses– Outdoor activity– Intraocular pressure reduction

alhokama

to reduce accomodative demandmost of the studies are non randomized and no conclusive results

alhokama

can be overnigth contact lenses or daily lensesmost of the studies were non randomized

Abdulrahman

cheng et al studied the effect of bifocals and prismatic bifocal spectacles on myopic progression in chinese canadian children. the author showed greater reduction of myopic progression and axial elongation at 2 years for children in bifocal and prismatic bifocals but didnot provide long term follow-up data Cheng D et al. Arch Ophthalmol 2010

Abdulrahman

Findings with atropine eye drops are equivocal and inconclusiveTong et al reduction in myopic group after using atropine in commparison with the placebo group after 2 years however during follow up atropine group had sinificantly higher progression rate (significant rebound myopia)Many clinician do not advocate using cycloplegic eye drops for treating myopic profession becasue of the rebound myopia and side effectMyopia can resume at faster rate once eye drops are withdrawnside effect of atropine is an issue

Abdulrahman

relatively selective M1 receptor and less likely cause cycloplegia and mydiriasisTan 2005 and Siatkowsi 2008 both showed excellent safety profile, less side effect and 50% reduction in myopic progression with pirenzepine 2% gel

Abdulrahman

sydeny myopia study in 2008 demonstrated a significant reduction in prevalence of myopia in children who spent more time outdoorsPossible explanation: low accommodative demand, increasing light intensity which increases depth of field by decreasing image blur


Association between myopia and cataract

– Many studies have suggested that increase in the axial length of the eye is associated with a lower mean age at the time of cataract surgery

• Myopia is a risk factor for cataract OR

• Myopic patients are less tolerant to cataract

– Praveen et al. Eye 2010. reported that high myopia was a powerful risk factor for the development of cataracts in young patient


Pathogenesis of myopic cataract

• Role of lipid peroxidation in the pathogenesis of myopic cataract– Oxidative damage of proteins in the lens is widely accepted as a

major factor leading to cataract formation– Oxidative damage occurs earlier in diabetic and myopic patients– Retina is rich with polyunsaturated fatty acids and subjected to

photic oxidative injury, especially under conditions such as diabetes and myopia associated with chronic hyopxia

– High concentration of malondiadlehyde (MDA) which is a lipid peroxidative product was seen in the vitreous and lens of diabetic and myopic patients with cataract

– Ferrari et al. British Journal of Ophthalmology 1996– Boscia et al. Invest Ophthalmol Vis Sci 2000– Simonelli et al. Exp Eye Res 1989


MDA GSH

GSSG



• Importance of vitreous liquefaction in cataract formation– Vitrectomy replaces the gel vitreous with liquid

and increases the risk for cataract– High myopia is associated with increased

liquefaction of the vitreous body and has been identified as a risk factor for cataract

– Stickler syndrome is associated with early cataract



• Importance of vitreous liquefaction in cataract formation– Conclusion

• Vitreous liquefaction is associated with nuclear cataract but it is age dependent

• Possible mechanisms:– Decrease diffusion of growth factors, ions, and metabolites because

of decrease pressure gradient between vitreous and lens– Exposure of the lens to elevated level of oxygen– Increased oxidative stress in the eye may contribute to vitreous

liquefaction and formation of nuclear cataract Harcopos et al. Invest Ophthalmol Vis Sci 2005 Barbazetto et al. Exp Eye Res 2004

alhokama

Talk about hyperbaric oxygen


Clinical Characteristics and Outcomes of Cataract Surgery in

Highly Myopic Eyes

• Purpose– To evaluate the clinical characteristic and

outcomes of cataract surgery in highly myopic eyes

– To investigate the role of high axial length as a risk factor for RD after cataract surgery


Clinical Characteristics and Outcomes of Cataract Surgery in

Highly Myopic Eyes

• Patients and methods– Retrospective comparative case-control study– A stratified systemic sample of cataract patients

who underwent cataract surgery during the period between 1998 and 2009

– Medical files of selected file number were retrieved and reviewed


Data Collected – Pre operative data

• Age• Sex• Past ocular history• Past medical history• Medications• Previous ocular surgeries• Ocular trauma• Preoperative uncorrected and best corrected visual acuity• Clarity of the cornea• Type of cataract• Fundus exam• Intraocular pressure• Axial length


Data collected

– Intraoperative data• Date of surgery• Type of anesthesia• Surgical technique• Level of surgeon• Occurrence of ruptured posterior capsule• Vitreous loss• IOL implantation• Position of IOL implantation


Data collected

– Postoperative data• Non corrected and best corrected visual acuity at last

visit• Post operative refraction• Presence of posterior capsular pacification• Rate of Nd:YAG capsulotomy• Retinal detachment• Mean time to retinal detachment• Postoperative follow up time


Exclusion criteria

– Age less than 20– Previous ocular surgery– Combined surgery– Ocular trauma– History of preoperative RD– Uveitis– Proliferative diabetic retinopathy– PRP done pre or post cataract surgery– Retinal diseases which predispose to RD such as stickler’s

syndrome and Marfan syndrome– Less than 1 year follow up


Definition of myopia

• Myopia can be defined by refractive or axial length

• Using refractive myopia, it is difficult to differentiate between cause and effect

• Most of the recent studies have used axial length as a definition for myopia

• Eyes with an axial length of ≥25.00 mm have been considered as having high myopia by large number of studies


Results

• Total withdrawn sample size was 2720• Number of eyes with high myopia (≥ 25.00

mm) that met the inclusion criteria was 352 eyes of 283 patients

• 500 eyes of 438 patients with axial length between 22.00 mm and ≤ 24.00 mm were selected to serve as controls


Results

• Mean follow up duration was 45.1 (27.9) months ranging from 12 to 144 months

• Follow up time:• Cases: Mean (SD), [min – max]: 46.2 (33.2), [1

– 12 Yrs]• Controls: Mean (SD), [min – max]: 47.5 (31.1),

[1 – 12 Yrs]


Age and cataract

Variable Cases Controls P value

No. (%) No. (%)

Age

Mean (±SD) 59.5( 11.3) 62.3 (10.7) < 0.0001

Range (20 – 85) (20 – 90)

The mean age of the case group was younger than that of control group

It is consistent with previous studies


Distribution of cases and controls by type of cataract

Nuclear cataract was strongly associated with high axial myopia Praveen Am J Ophthalmol 2008 Jeon Korean J Ophthalmol 2011 Blue Mountains Eye Study. Invest Ophthalmol Vis Sci 1999 Beaver Dam Eye Study. Invest Ophthalmol Vis Sci 2001

The association between PSC and high myopia was controversialBlue Mountains Eye Study and Jeon et al, found PSC to be more common among high myopic eyes while Praveen et al and other studies found PSC to be more common among emmetropic eyes


Distribution of cases and controls by type of surgery


PCO and rate of YAG capsulotomy among cases and controls

High myopic eyes might be less tolerant to PCO or the nature of PCO might be denser among high myopic eyes.Published rate of YAG capsulotomy in high myopic eyes is 20% to 50%

cos

Alio 2007 reported the rate of YAG following small incision cataract surgery to be 33%Jacobi et al 1997 reported 29% YAG rate after ECCE


Intraoperative complications among cases and controls

Type of Surgery Cases Controls P value No. (%) No. (%)

Post. Cap. Rupture 14 (3.9) 5 (1.0) 0.0606

Vitreous loss 8(2.2) 3(0.6)

Published data reported that intraoperative vitreous loss occurred in 1% to 2% of high myopic cases


Distribution of cases and controls by surgical indices


Distribution of cases and controls by surgical indices

Cases Control P Value

NO.(%) NO.(%)

IOL InserationAnterior 8(2.3) 3(0.6) 0.002

Posterior 302(85) 470(94)

Sulcus 18(5.1) 28(5.6)

Aphakia 7(1.9) 2(0.4)

Suegeon levelConsultant 249(70.7) 312(62.4) 0.0115

Resident 103(29.3) 188(37.6)

AnaesthesiaLocal 325(92.3) 479(95.8) 0.0305

General 27(7.7) 21(4.2)


Clinical indices outcomes


Retinal detachment and cataract surgery

• The incidence of retinal detachment either after extra-capsular cataract extraction by nuclear expression (ECCE) or phaco-emulsification has been estimated to be within the range of 0.6% to 2.7%

• Potential risk factors for retinal detachment after cataract extraction include – Male sex– Younger age– Ruptured posterior capsule/vitreous loss– Presence of atrophic retinal lesion– Retinal detachment in the other eye– Nd:YAG laser capsulotomy– High axial myopia


Risk of RD in high myopic eyes after cataract surgery

• The relationship between high axial myopia and retinal detachment after cataract extraction has been assessed and reported in many retrospective studies

• There is a considerable number of studies reported that high axial myopia increases the risk of retinal detachment after cataract extraction while many other studies have not found such increase

• The reported incidence varies between 0% to 8%


Risk of RD in high myopic eyes after cataract surgery

• The main difficulties in comparing different studies come from – Various definition used for high myopia– Variation in the follow up period– Different surgical technique– Hospital setting– Ethnicity– Inclusion and exclusion criteria


Incidence of RD

• RD across the whole group is 16/852 = 1.9%• RD among cases: 14/352 (4%)• RD among controls: 2/500 (0.4%)


Kaplan-Maier analysis for the risk of RD

The cumulative risk of onset of RD:2% at 12 months3.5% at 24 months4.4% at 48 months5.2% at 54 months


Survivorship Function over follow up time

Follow Up time (M)RD Incidence

No. (%)Probability Survive Probability RD

Event

0 - 12 7 (50%) 98% 2%

13 – 24 4 (28.6%) 96.6% 3.5%

25 – 36 2 (14.3%) 95.7% 4.4%

37 – 53 0 (0%) 95.7% 4.4%

54 + 1 (7.1%) 94.9% 5.2%


Phacoemulsification versus ECCE

• Phacoemulsification was reported to carry either similar or even lower risk than ECCE( Erie JC 2006, Nielsen NE 1993, Tielsch JM 1996, Russel M 2006, Tuft SJ 2006, Sharma MC 2003).

• Javitt et al found pseudophakic RD to be higher after phacoemulsification in years soon after its introduction (Javitt JC 1992)

Risk Factor Incidence of RD total Unadjusted

OR P value Adjusted OR P value

Type of Surgery ECCE 6 (3.7) 0.31 0.184 0.44 0.445

Phaco 6 (3.5) 0.29 0.169 0.37 0.323 Others 2 (11.1) -


Nd:YAG capsulotomy and retinal detachment

– Laser capsulotomy was reported to increase the risk of RD 4 fold

– However, it is difficult to come to conclusion from different studies regarding the risk of RD following Nd:YAG capsulotomy as using different energy might influence the changes occurring in the vitreous that may predispose to RD.

Risk Factor Incidence of RD total

Unadjusted OR P value Adjusted

OR P value

Yag Capsulatomy

Yes 1 (4.3) 1.1 0.999 1.13 0.912

NoV 13 (4)

cos

the incidence of RD following YAG varies in the published data from 0% to 0.89% to 10% Williams 2009

cos

it has been hypothesized that alteration in the structure of the vitreous induced by capsulotomy with accompaning traction on the retina, may be responsible. Javitt 1992yag capsulotomy will be followed by diffusion of hyaluronic acid toward the anterior chamber plays critical role in triggering depolimerization of the vitreous and causes PVDThe litrerature suggest that the posterior capsule opening rather than direct physical trauma from YAG is the primary factor contributing to RD


Ruptured posterior capsule+/- Vitreous loss

– Tielsch et al 1995, reported that intraoperative posterior capsular rupture increases the risk for retinal detachment fivefold


Age and RD among high myopic eyes

Risk Factor Incidence of RD total Unadjusted

OR P value Adjusted OR P value

No. (%) Age < 50 4 (7.1) 2.2 0.252 1.72 0.450

≥ 50* 10 (3.4)

A trend was found indicating association between age at surgery of younger than 50 years and an increased risk of RD


Gender and RD among high myopic eyes

– Male gender was found by several studies to be a high risk for RD following cataract extraction (Davidson 1988, Boberg 2003 JCRS, Olsen 2000, Erie 2006, Rowe 1995, Sheu 2010)

Risk Factor Incidence of RD Total

Unadjusted OR P value Adjusted

OR P value

Sex

Male 11 (5.5) 2.9 0.106 6.8 0.891

Female* 3 (2)


Conclusion

• Cataract surgery in high myopic eyes has excellent visual outcome but less than emmetropic eyes

• High myopic patients tend to have cataract surgery at younger age

• The incidence of intraoperative ruptured posterior capsule and postoperative YAG capsulotomy was higher in high myopic eyes


Conclusion

• Incidence of retinal detachment after cataract surgery is higher among high myopic eyes than emmetropic eyes

• Among high myopic eyes, being male, age <50, and ruptured posterior capsule with vitreous loss increases the risk of RD

• 5 years cumulative risk for RD is 5.2%


Conclusion

• Given the low incidence of postoperative RD, large number of cases are required for accurate analysis

• Our findings will be helpful in estimating the risks and benefits of cataract surgery in high myopic eye

• We would emphasize the importance of regular fundus examination after cataract surgery for high myopic eyes


Acknowledgment

• Dr. Ahmed Mousa• Dr. Dora Alharkan• Dr. Sultan Alreshidi• Dr. Tariq Almudhaiyan• Dr. Mohammed Alotaibi• Ms. Sara Alsuleiman

Myopia and Cataract Abdulrahman Al-Muammar Grand round Sep 12/2011 1myopia and catract.

Documents

Transcript of Myopia and Cataract Abdulrahman Al-Muammar Grand round Sep 12/2011 1myopia and catract.