January 27, 2004
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Array shows good vision at far and near in RLE

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KOLOA, Hawaii – The Array IOL provides good vision at distance and near in both hyperopes and myopes after refractive lens exchange, according to a surgeon speaking here. The risks of retinal detachment in myopic eyes after RLE should be reexamined in light of recent data, said Frank A. Bucci, MD, here at Hawaii 2004: the Royal Hawaiian Eye Meeting.

With a mean follow-up of almost 1 year, the Array provided uncorrected distance vision of 20/40 or better in 100% of 110 myopic patients and 97% of 161 hyperopic patients, Dr. Bucci said. At the same time, 87% of the myopes and 92% of the hyperopes saw J3 or better at near without correction, he said.

Dr. Bucci said he used astigmatic keratotomy at a 10-mm optical zone to correct astigmatism in any patient with 0.25 D or more of corneal astigmatism at no sooner than 3 weeks after RLE. Fifty percent of the myopes in the series and 16% of the hyperopes underwent AK. In the myopic eyes, a mean of 1.08 D of astigmatism before any surgery was reduced to 0.46 D after CLE and AK. In the hyperopic eyes, a mean of 0.65 D of astigmatism before any surgery was reduced to 0.36 D after RLE and AK, he said.

There was no loss of vitreous at the time of surgery, and there were no cases of retinal detachment or cystoid macular edema postoperatively in this series of eyes, Dr. Bucci said. He noted that reports from 10 years ago and more described a high incidence of retinal detachment in myopic eyes after RLE. But he said that with modern methods of clear corneal phaco and careful patient selection – including limiting surgery to patients with less than 25 mm axial length – a reassessment of the risks of the procedure in myopes is warranted.

Dr. Bucci said patient selection is one of the most important factors in the success of RLE with the Array.

“I could do a whole hour lecture on what characteristics to be wary of in your patients,” he said. In general, patients with demanding, introspective or “type A” personalities, and those who do a lot of near work, such as engineers, should not be candidates, he said. A strong preoperative desire for spectacle independence is highly correlated with success, he said.