dr sami a.dassan _ clear lens extraction _ medics index member contribution

8/8/2019 Dr Sami a.dassan _ CLEAR LENS Extraction _ Medics Index Member Contribution

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CLEAR LENS EXTRACTION CLEAR LENS EXTRACTION FOR CORRECTION OF FOR CORRECTION OF

HIGH MYOPIAHIGH MYOPIA



REFRACTIVE UNIT REFRACTIVE UNIT

KING HUSSEIN MEDICAL CENTER KING HUSSEIN MEDICAL CENTER

ROYAL MEDICAL SERVICES ROYAL MEDICAL SERVICES



Wajih Abd allat MDWajih Abd allat MD

S ami Dassan MDS ami Dassan MD

I ssam Batayne MDI ssam Batayne MD

Wael Abu Wael Abu- -Laban MDLaban MDK halil Al K halil Al - -R awashd eh MDR awashd eh MD

Ayman M ad anat MD Ayman M ad anat MD



DEFINITION DEFINITION

- Clear Lens Extraction ( CLE) is essentially cataract surgery

but exclusively for refractive purposes.

-- CLE is sometimes called Refractive Lens Exchange (RLE).

-- CLE is also called Refractive Lens Replacement ( RLR).



DEFINITION DEFINITION

--It is the removal of the noncataractous natural lens of the

-eye with or without intraocular lens (IOL) replacement

as a refractive procedure.

--The replacement IOL is of a power to correct most, if not

all , of the patient¶s hyperopia or myopia or even

astigmatism if toric lenses are used.



HISTORY HISTORY

CLE is not a new technique.

First described by Boerhave in 1708,

Fuukula may be considered the creator of CLE.Von Graefe described the risks of the procedure 150 years

ago.

In the past 10 years CLE has slowly become accepted as a

viable alternative to other refractive procedures for selected patients.



INDICATIONS INDICATIONS

- H igh myopia ( > 8 D )

- H igh hyperopia (> 4D)

-- H igh anisometropia.

-- Presbyopia.

-- Children: ammetropia,anisometropia with neurobehavioral

-disorders.

-- Peripheral lens opacities despite a clear central crystalline

lens.

-- Keratoconus.



ADVANTAGES ADVANTAGES

- Years of successful history.

-- Cornea is relatively untouched.

-- Good alternative in thin and problematic corneas.

-- IOL may be exchanged .

-- Bioptic (fine tune) procedure if accompanied by other

-refractive procedures.

-- No possibility of developing cataract in the future.



DISADVANTAGES DISADVANTAGES

- M ore invasive procedure than any cornea-based refractive

procedure or even phakic IOLs.

- Extremely high myopic patients have an elevated risk of

vitreal or retina problems after surgery.

- Loss of accommodation.



AIM AIM

To establish the outcomes and incidence

of complications following Clear Lens Extraction for correction of high

myopia over a period of one year .



PATIENTS PATIENTS

- Fifteen eyes of 15 patients.

- Period, from M ay 2006 to Augusts 2007.- Age, ranged fro 27 to 62 years ( mean = 44

years ).



PATIENTS PATIENTS

- S ex, nine patients were females and six

were males.- Refractive error, ranged from -13 to -28

Diopters spherical equivalent

( mean = 18.36 D ).

- Follow up, ranged from 6 to 15 months

(mean 12 months).



METHODS METHODS

- Patients where the degree of myopia exceeded that

which could safely be corrected by cornea-based laser

refractive surgery were included.

- Preoperative evaluation: corneal topography, corneal

pachymetry, autorefractometry, UCVA, BCVA, full

opthalmic history: anteior and posterior segments,detailed

retinal examination, full medical history.



METHODS METHODS

-- IOL calculation was done by the A-scan ultrasonic biometry

-using the S RK-T regression formula with ±1 D target.

-

- Risks and benefits of the surgery were discussed with the- patients at length.

-- Lens was removed by phacoemulsification technique or by

-extra capsular cataract extraction( ECCE), under local

-anaesthesia.



METHODS METHODS

-The lens removal is similar to normal phacoemulsification for cataracts .

-Even using the classical extra-capsular cataract extraction will be sufficient with a good attention in making a small incision.

-All the rest steps intra and post op are exactly the same.



RESULTS RESULTS

- Posterior monofocal IOL implantation was done

successfully in 14 cases ( one rupture of

posterior capsule)

- Postoperatively, the mean refraction S E was

± 1.75 D ranging from +1.25 to ± 2.75 D(

(IOL patients)



RESULTS RESULTS

- Eleven of the 15 patients ( 73% ) were

within 1 D of emmetropia

- Twelve of the 15 patients ( 80% ) had

uncorrected visual acuity of 6/12 or better



RESULTS RESULTS

- Four of the 15 patients ( 27% ) had UCVA

of 6/6 or better

- The BCVA was improved in all patients

- Posterior capsule opacification was noted in

2 patients of the 15 ( 1.3% ) which

needed YAG laser capsulotomy



RESULTS RESULTS

- No retinal detachment was noted

during the follow up period.

- All patients were satisfied .



CONCLUSION CONCLUSION

Clear lens Extraction is technically

easy to perform and effective when followed by implantation of low or

negative power intra-ocular lenses

for myopia.



CONCLUSION CONCLUSION

-Refractive lens exchange results in rapid and predictable improvement in unaided vision

in patients with high myopia.

-The risks of sight threatening complications

inherent in any intraocular procedureunderlie the need for appropriate patient selection.

dr sami a.dassan _ clear lens extraction _ medics index member contribution

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