Clear lens extraction, also known as refractive lensectomy, custom lens replacement or refractive lens exchange is a surgical procedure in which clear lens of the human eye is removed. Unlike cataract surgery, where cloudy lens is removed to treat cataract, clear lens extraction is done to surgically correct refractive errors such as high myopia. It can also be done in hyperopic or presbyopic patients who wish to have a multifocal IOL implanted to avoid wearing glasses. It is also used as a treatment for diseases such as angle closure glaucoma.
| Clear lens extraction | |
|---|---|
| Other names | Refractive lensectomy or Refractive lens exchange[1] |
| Specialty | Ophthalmology |
Overview
editAs opposed to procedures that use lasers to make corrections to the corneal surface, such as LASIK, the clear lens extraction procedure uses the same procedures as cataract surgery.[1]
Indications
editClear lens extraction can be done in patients with severe refractive error and/or presbyopia who wish to avoid spectacles.[2][3] It is often necessary in patients with severe refractive error who cannot undergo other refractive procedures such as LASIK or photorefractive keratectomy.[2]
Clear lens extraction is also used as a treatment of choice in patients with diseases such as angle closure glaucoma.[4] A study also found that CLE is even more effective than laser peripheral iridotomy in patients with angle closure glaucoma.[5][6] A systematic review comparing lens extraction and laser peripheral iridotomy for treating acute primary angle closure found that lens extraction potentially provides better intraocular pressure control and reduces medication needs over time. However, it remains uncertain if it significantly lowers the risk of recurrent episodes or reduces the need for additional surgeries.[7]
Procedure
editProcedure is similar to cataract surgery, most commonly followed by an intraocular lens implantation. In patients requiring only distance vision correction, a conventional mono-focal intraocular lens is placed in both eyes after the clear lens is removed.[1] While distance vision is fine in this, reading glasses are required for near vision.[1] Another method is to correct one eye only for distance vision and the other eye for near vision only.[1] The best way to achieve both distance vision and near vision is to place multifocal IOLs or accommodating IOLs in both eyes.[1][8]
The intraocular lens power calculations for clear lens extraction is similar to calculations used for conventional cataract surgery.[8]
Under topical anesthesia, through a 2.2 mm corneal incision, the lens nucleus and cortex are removed by irrigation and aspiration technique using a phaco machine.[9] After removal of lens material, the viscoelastic solution initially instilled is removed from the anterior chamber, intraocular lens is inserted and the corneal wound is closed by stromal hydration method.[9] In some people with very high myopia, the eye may be left aphakic, without intraocular lens implantation.[10]
Complications
editIn addition to the common complications of cataract surgery, clear lens extraction may also cause premature posterior vitreous detachment and retinal detachment,[2] particularly in patients with high Myopia. However, modern surgical techniques and advanced lens technology have significantly reduced the likelihood of this and other complications. The procedure is generally safe and effective when performed by experienced surgeons, with most patients experiencing improved vision post-surgery without major complications. [11]
History
editAs opposed to the more commonly performed cataract treatment, the idea of removing the lens exclusively for refractive purposes first emerged in the 18th century.[12] French ophthalmologist Abbé Desmonceaux may be the first to suggest such an operation in 1776 for a patient with high myopia.[12] He recommended the operation to Baron Michael Johann de Wenzel, although it is not known whether he ever performed the operation.[13]
The first systematic work on clear lens extraction was carried out by Polish ophthalmologist Vincenz Fukala in Vienna. Fucala advised clear lens extraction in young high myopic (−13 diopters or more) patients with poor vision and inability to work.[12]
References
edit- ^ a b c d e f "Clear Lens Extraction (CLE)". Moran Eye Center | University of Utah Health. 13 September 2021. Archived from the original on 28 July 2023. Retrieved 28 July 2023.
- ^ a b c "Clear Lens Extraction - EyeWiki". eyewiki.org. Archived from the original on 2023-07-28. Retrieved 2023-07-28.
- ^ Michelle, Stephenson. "A Review of Refractive Lens Exchange". Review of Ophthalmology. Archived from the original on 2023-07-28. Retrieved 2023-07-28.
- ^ "Clear Lens Extraction: First-Line Treatment for Primary Angle-Closure Glaucoma?". American Academy of Ophthalmology. 28 October 2017. Archived from the original on 28 July 2023. Retrieved 28 July 2023.
- ^ Azuara-Blanco, Augusto (2013-01-18). "The effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: a randomised controlled trial (EAGLE)". doi:10.1186/isrctn44464607.
- ^ Tanner, Luke; Gazzard, Gus; Nolan, Winifred P.; Foster, Paul J. (January 2020). "Has the EAGLE landed for the use of clear lens extraction in angle-closure glaucoma? And how should primary angle-closure suspects be treated?". Eye. 34 (1): 40–50. doi:10.1038/s41433-019-0634-5. ISSN 1476-5454. PMC 7002615. PMID 31649349.
- ^ Ong, Ariel Yuhan; McCann, Paul; Perera, Shamira A; Lim, Fiona; Ng, Sueko M; Friedman, David S; Chang, Dolly (2023-03-08). Cochrane Eyes and Vision Group (ed.). "Lens extraction versus laser peripheral iridotomy for acute primary angle closure". Cochrane Database of Systematic Reviews. 2023 (3). doi:10.1002/14651858.CD015116.pub2. PMC 9994579. PMID 36884304.
- ^ a b Alió, Jorge L.; Grzybowski, Andrzej; Romaniuk, Dorota (10 December 2014). "Refractive lens exchange in modern practice: when and when not to do it?". Eye and Vision. 1 (1): 10. doi:10.1186/s40662-014-0010-2. ISSN 2326-0254. PMC 4655463. PMID 26605356.
- ^ a b Joshi, RajeshSubhash (2020). "Clear lens extraction for patients who are unfit for laser-assisted in situ keratomileusis and implantable contact lenses in central Indian population". Indian Journal of Ophthalmology. 68 (12): 3002–3005. doi:10.4103/ijo.IJO_1307_20. PMC 7856966. PMID 33229686.
- ^ Azar, Dimitri T. (2007). "lenticular and scleralrefractive surgical procedures". Refractive Surgery (2nd ed.). Mosby / Elsevier. p. 13. ISBN 978-0-323-03599-6.
- ^ Hamilton, Rex. "Refractive Lens Exchange". Dr. Rex Hamilton M.D. Retrieved 2024-09-27.
- ^ a b c Themes, U. F. O. (10 October 2019). "Refractive Lens Exchange". Ento Key. Archived from the original on 28 July 2023. Retrieved 28 July 2023.
- ^ Schmidt, Dieter; Grzybowski, Andrzej (January 2013). "Vincenz Fukala (1847–1911) and the early history of clear-lens operations in high myopia". Saudi Journal of Ophthalmology. 27 (1): 41–46. doi:10.1016/j.sjopt.2012.11.002. PMC 3729753. PMID 23964186.