Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.
Eye volume 20, pages 1463–1464 (2006 )Cite this article 04>LRI
Cataract surgery in highly myopic eyes presents several challenges to the surgeon, ranging from choosing an appropriate intraocular lens, potentially complicated surgery, to possible postoperative complications. We here report the results of phacoemulsification with implantation of a negative power Big Bag™ posterior chamber intraocular lens (IOL) implant in both eyes of a patient.
A 65-year-old Asian lady with high myopia and best-corrected visual acuities of OD 1/60 (−18.0 DSph) and OS 6/60 (−19.0 DSph) was seen in our clinic. She was noted to have bilateral posterior subcapsular cataracts and fundii showed posterior staphyloma, which was confirmed by ultrasound examination. Biometry revealed an axial length of 31.50 and 31.72 mm in right and left eyes, respectively, and predicted IOL power (SRK/T formula) −12 D to achieve postoperative emmetropia. The unusual IOL power prompted us to use the Big Bag™ IOL (SD Ophthalmics), a single-piece foldable acrylic lens (overall diameter 10.35 mm) with a meniscus optic of 6.5 mm diameter and three windowed flat haptics available in 0.5 D steps from −10 to +13 D (Figure 1). The extended Tri-Haptic configuration offers 240∘ contact arc supporting the zonules (Figure 1).
Single-piece foldable acrylic lens with three windowed flat haptics.
Phacoemulsification was performed (right eye followed by the left eye) through a 2.8 mm clear corneal incision. IOL (−10 D) was implanted in the capsular bag after enlarging the incision to 3.2 mm. The capsulorrhexis was 5 mm in diameter and viscoelastic was aspirated with simcoe cannula through the sideport. Lens folding and implantation were difficult owing to the thick edge, and forceps was used instead of the injector. The surgery and the postoperative course remained uneventful. The patient was followed for a year and the IOL maintained excellent centration with good coverage of the pupillary area (Figure 2). The best-corrected postoperative visual acuities were OD 6/12 and OS 6/18. The final refractive error was within 1 D of the predicted refractive error.
Well-centred IOL with excellent coverage of the pupillary area.
Negative power IOL implants following cataract surgery have been reported using the conventional two-haptic IOL design.1, 2, 3, 4 The larger diameter of the capsular bag seen in highly myopic eyes5 led us to believe that the three-haptic design would prevent lateral displacement of the IOL and a larger optic diameter would minimise the likelihood of symptoms related to the IOL edge. Postoperative result as shown in Figure 2 appears to confirm this belief in this patient.
Negative power lens implants have a thick edge, which makes folding with conventional forceps difficult and the manufacturer recommends a special injector. Our case demonstrates that there is potential for use of this device as a refractive technique for highly myopic patients.
Kohnen S, Brauweiler P . First results of cataract surgery and implantation of negative power intraocular lenses in highly myopic eyes. J Cataract Refract Surg 1996; 22 (4): 416–420.
Jimenez-Alfaro I, Miguelez S, Bueno JL, Puy P . lens extraction and implantation of negative-power posterior chamber intraocular lenses to correct extreme myopia. J Cataract Refract Surg 1998; 24 (10): 1310–1316.
Pucci V, Morselli S, Romanelli F, Pignatto S, Scandellari F, Bellucci R . Clear lens phacoemulsification for correction of high myopia. J Cataract Refract Surg 2001; 27 (6): 896–900.
Guell JL, Rodriguez-Arenas AF, Gris O, Malecaze F, Velasco F . Phacoemulsification of the crystalline lens and implantation of an intraocular lens for the correction of moderate and high myopia: four-year follow-up. J Cataract Refract Surg 2003; 29 (1): 34–38.
Vass C, Menapace R, Schemetterer K et al. Prediction of pseudophakic capsular bag diameter based on biometric variables. J Cataract Refract Surg 1999; 25 (10): 1376–1381.
Department of Ophthalmology, Birmingham Midland Eye Centre, Dudley road, Birmingham, B18 7QU, UK
A Bhatnagar, S Somanathan & RAH Scott
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
Bhatnagar , A. , Somanathan , S. & Scott , R. Bilateral large-bag intraocular lens implants for highly myopic eyes .Eye 20, 1463–1464 (2006).https://doi.org/10.1038/sj.eye.6702346
DOI: https://doi.org/10.1038/sj.eye.6702346
Anyone you share the following link with will be able to read this content:
Sorry, a shareable link is not currently available for this article.
Provided by the Springer Nature SharedIt content-sharing initiative
Conjunctiva Forceps Eye (Eye) ISSN 1476-5454 (online) ISSN 0950-222X (print)