ICL implantation is currently a good treatment for high myopia. However, because of individual patient differences, different levels of surgical proficiency and different lens positions, cataracts of varying degrees will occur in about 3.5% of patients. Also highly myopic patients are themselves prone to early cataracts, so this type of situation is sometimes encountered. However, the technology is now mature enough that ICL removal combined with cataract ultrasound emulsification and IOL implantation can be done and good vision will still be restored after surgery.
Recently we treated a patient with cataracts that occurred after many years of ICL using the most advanced femtosecond laser cataract technology and achieved good results. The patient’s main problem was that he had nearly 200 degrees of corneal astigmatism, and the IOL he needed to implant was only +4D because he was highly myopic, and there was no Toric lens with astigmatism correction at such a low level. So we used the femtosecond laser to correct his astigmatism at the same time, and the result was 0.8 vision on the first day after surgery!
Another difficulty with high myopic cataract surgery is the inaccurate measurement of the IOL. This is because the ratios of axis length and corneal curvature and anterior chamber depth in highly myopic eyes are very different from those in normal eyes, which leads to the fact that none of the conventional IOL measurement formulas are suitable for highly myopic patients, and the chance of farsightedness or myopic errors after surgery is very high. We adopted Shaowei Li’s empirical formula, the LSW1 formula, which resulted in very accurate calculations and ensured the patient’s outcome.
The patient’s preoperative nucleus pulposus was significantly cloudy and her visual acuity was only 0.2. We performed the surgery plus astigmatism correction with the femtosecond laser. One day after the surgery, the astigmatism was only 0.75D, the naked eye vision was 0.8, and the correction was 1.2.