Refractive lens exchange surgery in early-onset high myopia patients with partial cataract: a pilot study

Background: By reporting clinical characteristics and retinal image quality before and after refractive lens replacement surgery in early-onset high myopia (eoHM) patients presenting with partial cataract, we emphasized the need for an objective way to grade the severity of partial cataracts. Methods This retrospective, consecutive case series included six Chinese patients (nine eyes). Analysis of previous medical records, visual acuity, optometry, and axial length (AXL) before surgery and 2–4 years after surgery was performed. Retinal image quality was measured by the Optical Quality Analysis System and recorded as modulation transfer function cutoff frequency (MTF cutoff ) and objective scatter index (OSI) at the same time point. Results Five females and one male (nine eyes) with a mean (± SD) age of 11.6 ± 7.9 years were included in this study. The preoperative spherical power ranged from − 7.5 D to -42 D. The mean follow-up time was 36 (36–36) months (range: 24–48 months). Phacoemulsification was followed by in-the-bag implantation of intraocular lens. For younger patients who could not cooperate with postoperative laser capsulotomy, posterior capsulotomy + anterior vitrectomy were performed simultaneously. All surgeries were uneventful and no postoperative complications occurred during the entire follow-up period. Four eyes underwent YAG-laser capsulotomies at 12–18 months postoperatively. Initial spherical correction (treatment achieved) averaged 18.25 ± 11.15 D (range: 7.75-44 D). All patients’ uncorrected visual acuity improved by ≥ 2 lines postoperatively. LogMAR BCVA was significantly improved at 24-month (95%CI: 0.015–0.878, p  = 0.042) and endpoint (95%CI: 0.008–0.909, p  = 0.046) follow-ups. MTF cutoff and OSI was significantly improved at 12-month ( p  = 0.025, p  = 0.038), 24-month ( p  = 0.005, p  = 0.007) and endpoint ( p  = 0.005, p  = 0.008) follow-ups. Postoperative AXL remained stable during 2–4 year follow-ups compared to the pre-operative value ( p ༞0.05). Eight eyes (0.89%) exhibited myopia shift (~-0.5 D/year except for case 3), whereas case 5 (age 25) showed hyperopic change. Conclusion Refractive lens replacement surgery is safe and effective for improving functional vision in eoHM patients presenting with partial cataract. Retinal image quality could provide a useful and objective way to facilitate partial cataract severity evaluation and surgery decision making.