Comparison of minus power anterior chamber intraocular lenses and myopic epikeratoplasty in phakic eyes.

We performed a retrospective study of two sequential series of operations designed to correct high myopia in phakic eyes. The first series consisted of 21 eyes with refractive error ranging from -11.00 diopters to -21.00 D (mean -16.9 D). They received a commercially prepared, lyophilized, myopic epikeratoplasty lenticule sutured into a circular keratectomy. Seven lenticules had to be removed within the first year because of poor refractive results, corneal ulceration, or melting. The nine eyes followed from 12 to 24 months after surgery demonstrated residual refractive errors from +4.00 D to -11.25 D. We also studied an initial series of 41 eyes with preoperative myopia ranging from -9.00 D to -35.00 D (mean -15.00 D) that received a minus power anterior chamber intraocular lens. The lens had an open loop design with an anterior vault, four point angle fixation, and an optic diameter of 4.5 mm. Recovery of visual acuity was faster with the intraocular lens than with epikeratoplasty. Three intraocular lenses were removed; two because they were the wrong size and one because it was the wrong power. Two of the lenses were replaced with acceptable results. Of the 34 eyes followed for 12 months, all had a residual refractive error within +/- 2.00 D of emmetropia. During the short-term follow-up, no elevated intraocular pressure, cataract formation, or excessive endothelial damage was observed. We concluded that anterior chamber minus power intraocular lenses gave more rapid and predictable optical correction in high myopic eyes than did myopic epikeratoplasty. Longer follow-up is required before conclusions can be reached about the safety of these intraocular lenses.