CASE REPORT article
Front. Med.
Sec. Ophthalmology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1450922
Intraocular lens calculation for cataract surgery in high myopia: a case report of an extreme axial eyeball length of 35.7 mm
Provisionally accepted
Andreas F. Borkenstein*
Eva-Maria Borkenstein- Borkenstein & Borkenstein at Private Clinic Cross Sisters Graz, Graz, Austria
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Extreme axial eyeball length is a known risk factor for decreased accuracy of intraocular lens calculations. We report a case of a 35-year-old male with anisometropic amblyopia and an axial length of 35.7 mm in his right eye. To the best of our knowledge, this is a case of one of the longest eyeballs ever scientifically reported. The patient presented with presenile cataracts in the right eye, hand movement visual acuity, and required cataract surgery. Due to his high anisometropia, he was unable to wear spectacle correction prior to surgery in the amblyopic eye. The left (non-amblyopic) eye had moderate myopia and corrected to 20/20 with no signs of cataracts. Various intraocular lens (IOL) calculations were compared, aiming for a slight postoperative residual myopia in the right eye (approx. -1.50 D). The patient required a minus-power intraocular lens, and an IOL with a larger overall diameter (model 92S “Bigfoot IOL” manufactured by Morcher GmbH, Stuttgart, Germany) was selected. On the last available visit at six months, his refractive error was -1.50 D -0.75 D x 179° with a corrected visual acuity of 20/63. The large IOL was stable in the capsular bag, and there were no postoperative complications. The patient was able to wear spectacles with correction in both eyes and reported significant improvement in binocular vision and quality of life. Negative power IOLs typically have different optic configurations and require special considerations during IOL calculation. Care should be taken to avoid postoperative hyperopic refractive error. Nowadays, surgeons can choose from a selection of traditional formulas, newer-generation formulas, and axial length adjustment techniques to improve refractive predictability of eyes with extreme axial myopia. With this case report, we would like to demonstrate that even in rare cases of extreme, high myopia and eyeball length > 35 mm, good results can be achieved with correct IOL power implantation if certain considerations are made prior and during the procedure. Special considerations should be taken into account to maximize patient satisfaction.
Keywords: Intraocular lens calculation, High myopia, extreme axial length, Anisometropia, Biometry
Received: 18 Jun 2024; Accepted: 09 Jun 2025.
Copyright: © 2025 Borkenstein and Borkenstein. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Andreas F. Borkenstein, Borkenstein & Borkenstein at Private Clinic Cross Sisters Graz, Graz, Austria
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