To evaluate the efficacy and complications of cataract surgery in high myopia patients, a comprehensive search query was conducted from 2000 to 2020. Close to 20,000 highly myopic eyes from 28 studies were included.

Modern cataract surgery is shown to be effective in this patient population; however, related complications such as posterior capsular rupture (PCR) occurred (3.91% of cases), which is significantly higher than the rate of previous studies.

“Higher PCR incidence in high myopia population may be attributed to zonular weakness, which enhances the forward-and-backward movement of lens during surgery, and lack of mechanical support for lens due to vitreous liquefaction and posterior vitreous detachment (PVD),” the authors of this study said. “Furthermore, our study indicated that the rate of PCR in highly myopic eyes decreased significantly in more recent studies, which may result from the continuous advancements of surgical techniques and devices.”

Other complications that occurred include retinal detachment (RD) (1.7%), progressed myopic traction maculopathy (5.1%), capsular contraction syndrome (2.1%), intraocular lens dislocation (IOL) (0.6%) and transient intraocular pressure elevation (28.2%).

In conclusion, while cataract surgery was effective for highly myopic cataract patients, careful precautions and sufficient follow-ups were of great value due to higher incidences of intraoperative and postoperative complications. The authors suggest more attention and longer follow-up duration.