| Purpose:This study aims to compare the changes in Effective Lens Position(ELP)at different time points and the degree of tilt and decentration after phacoemulsification and IOL implantation surgery in highly myopic patients with cataract,in order to explore the timing and characteristics of intraocular lens stability in highly myopic patients with cataract,and provide a basis for achieving predictable and stable refractive status and good visual quality after surgery for highly myopic patients with cataract.Methods:A total of 28 highly myopic patients(42 eyes)who visited the cataract department of the Second Hospital of Jilin University from July 2022 to February2023 were enrolled in this study,including 13 males and 15 females.All surgeries were performed by the same surgeon.The patients were divided into two groups: one group received HOYA iSert 250 IOLs(20 eyes),and the other group received Rayner Superflex 920 H IOLs(22 eyes).Patient data were collected,including:(1)preoperative data,such as age,gender,eye side,refraction,intraocular pressure,ocular ultrasonography,and ocular biometry using IOL Master 700;(2)postoperative data,including measurements taken at 1 day,1 week,1 month,and 3 months after surgery.Ocular biometry was performed using IOL Master 700 to obtain postoperative ELP.Tilt 4,Tilt 6,total higher-order aberrations,spherical aberration,coma,and trefoil were measured using OPD-Scan Ⅲ.The eccentricity of the position of the IOL was measured using Image J software based on the images obtained from OPD-Scan Ⅲ.Results:1.The uncorrected visual acuity and best corrected visual acuity of highly myopic patients improved significantly after surgery at each follow-up time point,with statistical significance(P<0.05)compared to pre-operation.2.After implantation of two different types of intraocular lenses,there was no statistically significant difference(P>0.05)in uncorrected visual acuity and best corrected visual acuity of highly myopic patients at each follow-up time point.3.The effective lens position(ELP)of highly myopic patients changed slightly within one week after surgery(P>0.05),increased slightly from one week to one month after surgery(P>0.05),and the axial position of the intraocular lens changed the most from one week to one month after surgery,followed by from one day to one week after surgery,and the change was the smallest from one month to three months after surgery.4.There was no significant difference(P>0.05)in the tilt values of HOYA iSert250 and Rayner Superflex 920 H in highly myopic eyes.The tilt of the intraocular lens increased significantly(P<0.05)within one day to three months after surgery when the pupil diameter was 4mm,and within one week to one month after surgery when the pupil diameter was 6mm,while it increased slowly from one day to one week after surgery,and from one month to three months after surgery(P>0.05).5.There was no significant difference(P>0.05)in the decentration of HOYA iSert 250 and Rayner Superflex 920 H in highly myopic eyes.The intraocular lens showed significant decentration(P<0.05)within one day to one month after surgery,and slight decentration from one month to three months after surgery(P>0.05).6.There was no statistically significant difference(P>0.05)in total high-order aberrations,coma,and trefoil aberrations between HOYA iSert 250 and Rayner Superflex 920 H in highly myopic eyes.Compared with the HOYA group,the Rayner group had a significant increase in spherical aberration(P<0.05).7.When the pupil diameter was 4mm,the total ocular higher-order aberrations significantly increased from one day to one month after surgery(P<0.05),followed by a slow increase from one month to three months after surgery(P>0.05).Spherical aberration fluctuated within the first three months after surgery(P<0.05).Coma aberration significantly increased from one week to one month after surgery(P<0.05),followed by a slow increase from one month to three months after surgery(P>0.05).Trefoil aberration significantly increased from one day to one month after surgery(P<0.05),followed by a slow increase from one month to three months after surgery(P>0.05).8.When the pupil diameter was 6mm,the total ocular higher-order aberrations significantly increased from one day to one week after surgery(P<0.05),followed by a slow increase from one week to three months after surgery(P>0.05).Spherical aberration showed a slow increase within the first three months after surgery(P>0.05).Coma aberration significantly increased from one week to one month after surgery(P<0.05),followed by a slow increase from one month to three months after surgery(P>0.05).Trefoil aberration significantly increased from one day to one month after surgery(P<0.05),followed by a slow increase from one month to three months after surgery(P>0.05).Conclusion:1.Patients with high myopia and cataracts who undergo phacoemulsification with intraocular lens implantation experience significant improvements in uncorrected distance visual acuity and best-corrected visual acuity.2.Patients with high myopia may experience axial and horizontal movement of the intraocular lens within the first month after cataract surgery,but this tends to stabilize after one month.3.Total higher-order aberrations,coma aberrations,and trefoil aberrations continue to increase in patients with high myopia for up to three months after cataract surgery,with the most significant increase occurring within the first week to one month after surgery,and increased slowly from one month to three months after surgery.Spherical aberration remains almost unchanged.4.Both HOYA iSert 250 and Rayner Superflex 920 H intraocular lenses have good axial stability in highly myopic eyes,although there may be some axial movement of the intraocular lens in the short term,which does not significantly affect uncorrected distance visual acuity and best corrected visual acuity.However,both types of intraocular lenses still have room for improvement in terms of their horizontal stability within the eye.Improving the horizontal stability of the intraocular lens and minimizing the increase in postoperative higher order aberrations are the common goal for ophthalmologists and researchers. |
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