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Refractive Lensectomy

Persons who would benefit the most from this procedure include those with high degrees of nearsightedness or farsightedness, beyond what is easily corrected with ring segments or laser corrective options. This is also a beneficial procedure for people with signs of early cataract development, and most people over the age of 60 who are dependent on corrective lenses for distance vision.

Specific advantages of Refractive Lensectomy
Advantages include correction for most ranges of nearsightedness and farsightedness, a predictable outcome, fast visual stabilization, and minimal side effects. This procedure can be combined with laser or incision corrective options to correct astigmatism; it eliminates the need for cataract surgery in the future, and has a long history of successful outcomes, unlike some other methods of refractive surgery.

How Refractive Lensectomy works
Unlike laser corrective surgeries that alter the shape of the cornea, a refractive lensectomy changes the focusing power of the lens within the eye. For this procedure, the eye’s natural lens is removed and replaced by a manufactured lens implant that has been selected to provide clear focusing ability. The lens implant remains within the eye, without needing any further care after surgery. It provides a wide range of focusing freedom, but since it is a fixed focus lens, glasses are necessary for all near vision activities such as reading.

A refractive lensectomy is generally not recommended for people under the age of 45, unless the diagnosis and careful testing reveals it to be the best option. People under the age of 45 still have significant flexibility in their natural lens, which allows them to vary their focus naturally. This ability is lost in a lensectomy procedure.

This ability is lost during the natural aging process, and so those between the ages of 50 and 55 may not lose a significant amount of natural focusing flexibility through this procedure.

A refractive lensectomy is usually a simple outpatient procedure. Patients lay on a surgical table. Attentive assistants ensure that patients are very comfortable as they drape them with sterile sheets in preparation for surgery. Patients are not put to sleep, but they can be sedated with oral or intravenous medications, if necessary. Only the selected eye is “frozen” for this painless surgery. In most cases, topical drops are used to anesthetize the eye, and so no injection is necessary.

The refractive lensectomy procedure is similar to modern cataract surgery. To begin, the surgeon makes a small incision of 1/8 of an inch (2.8 mm) in either the white sclera or on the edge of the cornea. The surgeon inserts a delicate instrument to create a smooth, round opening in the outer capsule of the natural lens. Using an ultrasonic suction probe, the surgeon proceeds to gently break up and suction out the gel from the lens capsule. Then, the surgeon inserts a high quality lens implant of appropriate power and positions it securely within the natural lens capsule. Dr. Proffitt generally uses foldable lens implants, which are inserted through the tiny incision and then open up inside the eye where they are positioned to provide clear vision. For extremely high corrections, foldable lenses are not manufactured, and so the incision is enlarged for the placement of a more rigid lens implant. The surgery is usually completed without stitches, since the incision is designed to be self-sealing. The entire procedure takes around 15 minutes.

Some lens implants can correct astigmatism. If needed, other surgical procedures can be combined with lens implantation to solve astigmatism focusing problems.

After Surgery Expectations
Visual recovery from a refractive lensectomy, in most cases, is fast and dramatic. Shortly after the surgery, patients are usually able to see well enough to engage in regular activities with increased visual freedom.

Side effects are minimal. Most patients experience some temporary blurring for a few days from tear film variations or some fluid in the cornea. Patients can also expect increased light sensitivity for a few weeks, and so sunglasses need to be worn more often than usual during this time.

The lens capsule closes around the new lens implant in the weeks following surgery, sometimes changing the focusing range to a small degree because of a shift in position. If the stable visual result is not ideal, a second surgical procedure to adjust or replace the lens is possible. An additional laser surgery to improve the focus is also possible.

Possible Complications
As with any surgery, there are some possible complications to a refractive lensectomy. However, the risks are minimal. In general, they are the same as with cataract surgery.

Increased Possibility of Retinal Detachment. Farsighted people have a very low risk of detachment, however, most nearsighted people have eyes that are longer than normal, resulting in retinas that are more vulnerable to detachments. The risk of retinal problems because of surgery is extremely small. A retinal examination required before the surgery helps to determine the risk factors for each patient. Even if a detachment occurs, it can generally be effectively repaired.

Inner Eye Surgery Complications. The following complications are very uncommon, but they can occur: hemorrhage or infection within the eye, swelling around the eye, reflections or sight distortions from the lens implant, an increase of floaters, loss of corneal clarity, dislocation of the lens implant, wound leak, glaucoma and uveitis (inflammation). Most of these complications can be effectively treated if they occur.

Corneal Surface Surgery Complications. The corneal surface problems of induced astigmatism and slightly increased dryness are not generally serious and may be effectively treated.

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