International consensuses and guidelines on clinical management of highly myopic cataracts: A two-round modified e-Delphi study by the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) and the Asia-Pacific Myopia Society (APMS)

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PURPOSE: As the prevalence of high myopia increases around the world, the incidence of highly myopic cataract (HMC) would increase and present clinicians with unique management challenges. This modified Delphi consensus study aimed to establish practical recommendations for HMC diagnosis and treatment, addressing key controversies in preoperative evaluation, surgical considerations, and postoperative care. METHODS: An international panel of 30 cataract experts from 14 countries/territories participated in this two-round e-Delphi study. Consensus was defined as ≥ 75% agreement on 5-point Likert-scale statements covering disease characterization, preoperative evaluation, intraoperative precautions, and postoperative care. RESULTS: A formal consensus was reached by a broad majority of the panel (86.67%) to endorse HMC as a separate disease category, typically manifesting 10-20 years earlier than age-related cataracts. Key consensus included: use of combined IOL formula calculations (96.67% agreement), preference for hydrophobic acrylic intraocular lens (96.67%), and mandatory 3-month postoperative retinal exams (96.67%). Controversies persisted regarding immediate sequential bilateral surgery, prophylactic routine implantation of a capsular tension ring, and postoperative steroid regime. CONCLUSIONS: We present commonly agreed recommendations for the clinical management of HMC, which include tailored surgical approaches and vigilant postoperative monitoring to address this growing public health challenge.

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