Departments

Department of Refractive Surgery

What happens with high refractive abnormalities?

In higher ametropias, myopias over 10-11 degrees (diopters) and hyperopias over 4-5 degrees, the 15-year experience with laser showed that we achieve best results with conventional operations or a combination of conventional operations with laser. This is so because the thinning of the cornea is above the accepted level in very high myopias and hyperopias and the eye’s safety is at risk. Very high ametropias are best treated surgically with the insertion of permanent intraocular lenses (lenses that are placed in the eye). There are special intraocular contact lenses which are placed either behind the iris (ICL) or in front of the iris (ARTISAN, PHAKIC 6).

The advantage of this method is that it is reversible. In other words, the lens may be removed if necessary, something which is not possible with the laser operation. For better and more anticipated results, these techniques are combined with laser (bioptics), which is applied shortly after the intraocular lens has been placed and a final ocular acuity is determined. We use the laser to achieve the desired results, correcting the remaining ametropia that is possibly left after the insertion of the lens.

If the natural lens of the eye is hazy and the patient is quite aged and has high myopia, an alternative intervention is refractive lensectomy (clear lens extraction), that is the removal of the eye's lens as in the case of the cataract and the insertion of a corrective intraocular lens. The refractive lensectomy is best indicated for aged people with high myopias who at the same time, are thus able to avoid early on a possible removal of a cataract.

In high astigmatism, astigmatic cheratotomies can be made, ie. small incisions on the cornea facing each other, to change its uneven curvature. In pathological situations as in keratoconus where we have very high astigmatism, there is an indication for cornea transplant.