Predictors Of Visual Recovery After Cataract Surgery In High Myopes
Keywords:
High Myopia, Cataract Surgery, Phacoemulsification, Pathological Myopia, Axial Length, Posterior Staphyloma, Visual Outcome, Intraocular Lens.Abstract
Objective: To describe the demographic, refractive, biometric, and fundus characteristics of patients with high myopia undergoing cataract surgery, and to identify the clinical factors associated with limited postoperative visual recovery.
Materials and Methods: This retrospective observational case series included 70 consecutive patients (131 eyes) with high myopia (spherical equivalent ≤ −6.00 D) who underwent phacoemulsification with posterior chamber intraocular lens (IOL) implantation. Preoperative demographic data, refractive error, presenting visual acuity, cataract morphology, axial length, keratometry, and dilated fundus findings were recorded, along with intraoperative course, IOL power, target postoperative refraction, and postoperative best-corrected visual acuity (BCVA) and complications.
Results: The cohort comprised 37 males and 33 females (mean age 54 years; range 30–75), with bilateral high myopia in 87.1% (approximately 131 eyes) and a mean spherical equivalent of −10 to −11 D. Nuclear cataract predominated (57.1%), and mean axial length was approximately 28.0 mm. Pathological myopia was identified clinically in 25.7% of patients, most often manifesting as posterior staphyloma. Phacoemulsification with PCIOL implantation was uneventful in 90.0% of cases; posterior capsular rupture occurred in 4.3%. Postoperatively, 57.1% of eyes achieved a BCVA of 6/12 or better and 70.0% achieved 6/18 or better. Among eyes with limited recovery (n = 19), myopic macular/chorioretinal atrophy (n = 7), posterior staphyloma with macular involvement (n = 3), and residual refractive error (n = 3) were the leading identifiable causes; poorer outcomes also correlated with increasing axial length, particularly ≥29 mm.
Conclusion: Cataract surgery produces substantial visual improvement in most highly myopic eyes, but pre-existing pathological myopia — principally macular atrophy and posterior staphyloma — together with increasing axial length, places a ceiling on achievable vision independent of surgical success. Thorough preoperative fundus evaluation and realistic patient counselling remain essential in this population.
