Rotation and decentration of an undersized plate-haptic trifocal toric IOL in an eye with moderate myopia: case report

Session Details

Session Title: Pseudophakic IOLs: Toric II

Session Date/Time: Sunday 11/09/2016 | 16:00-18:00

Paper Time: 17:46

Venue: Auditorium C6

First Author: : B.Giers GERMANY

Co Author(s): :    R. Khoramnia   L. Weber   T. Tandogan   G. Auffarth           

Abstract Details

Purpose:

To present a case of postoperative decentration and rotation of a trifocal toric IOL due to insufficient fixation in a large capsular bag of a myopic eye.

Setting:

International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany

Methods:

A 56-year-old female patient presented with bilateral cataract and myopia. Uncorrected VA was 20/100 in the right and 20/200 in the left eye. Best corrected VA was 20/32 with -5.75 sph. in OD and 20/80 with -6.5 sph./-2.0 cyl./133° in OS. Preoperative biometry was performed using the IOL-Master, measuring a bulbus length of 26.07 mm in the right and 25.99 mm in the left eye and a cylinder of each -1.77 D at 173° in the right and at 178° in the left eye respectively.

Results:

One day after implantation of a single-piece plate haptic multifocal toric IOL (AT Lisa tri toric 939 MP, Carl Zeiss Meditech, Germany) with 11 mm overall diameter into the left eye UDVA was 20/50 and UNVA (at 40 cm) was 20/63. On slit-lamp examination the IOL was decentered and tilted to temporal inferior with the axis having rotated approximately 30° clockwise due to insufficient fixation in the large capsular bag. The lens was therefore explanted and exchanged with a single piece loop haptic bifocal toric IOL with 13 mm overall diameter (Tecnis ZMT 150, Abott Medical Optics, USA) by which stable fixation of the IOL within the capsular bag could be achieved. Postoperative UDVA was 20/25 and UNVA was 20/32.

Conclusions:

Rotation-free fixation of toric IOLs is important for visual outcome. Capsular bag size is difficult to assess preoperatively. Axial length and level of myopia do not necessarily predict abnormal capsular bag dimensions. In this case the capsular bag was too big for the implanted IOL, although neither level of myopia nor axial length were excessively high and implantation of the same IOL model did not lead to difficulties in similar patients.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a competing company, ... travel has been funded, fully or partially, by a competing company, ... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, ... research is funded, fully or partially, by a competing company, ... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented