Anti-dysphotopic IOL: update and progress

Session Details

Session Title: Pseudophakic IOL Power Calculation: Photic Phenomena after IOL Implantation

Session Date/Time: Sunday 08/10/2017 | 16:30-18:00

Paper Time: 17:42

Venue: Room 3.4

First Author: : P. Vamosi USA

Co Author(s): :    S. Masket   T. Neuhann   Z. Rupnik              

Abstract Details

Purpose:

Negative Dysphotopsia (ND) is an undesired optical complication of cataract surgery. Experience suggests that ND occurs only with “in-the bag” IOLs. When the optic is placed above the capsulotomy, ND is relieved or prevented. But, there are negative consequences if an IOL is not bag fixated. The Morcher 90S IOL was designed with a peripheral groove to accept the anterior capsule edge, allowing the bulk of the IOL to remain in the capsule bag with a portion overlying the capsule to avoid ND. The 90S IOL is CE marked and in use in limited clinical trails. Results are presented.

Setting:

Multiple European private practices and surgery centers

Methods:

Concurrent with cataract surgery, employing a laser automated or carefully guided anterior capsulotomy, the grooved IOL was implanted into the capsule bag and subsequently elevated to allow the capsule edge to be captured within the groove. Patients were followed following surgery with respect to optical outcomes and complications. An Excel spreadsheet was developed for outcomes analysis. Additionally, a specific brief and novel questionnaire was used to determine patient satisfaction and the presence or absence of dysphotopsia. Based on clinical experience, design changes were made in accord with observed complications.

Results:

Approximately 90 Morcher 90S IOLs have been implanted in 7 European sites. No patients have noted evidence of ND at any time, and acceptance has been excellent. Nevertheless, in early experience 3 cases developed “capsule block”, as the IOL lacked portals for fluid egress from the capsule bag. In a design modification, fenestrations in the peripheral optic-haptic junction were created, obviating the problem. Of note, the only present complication, pupil-optic groove capture has occurred in 4 cases, with 2 requiring IOL exchange. However, the absence of ND is extremely encouraging as are other advantages of anterior capsulotomy supported IOLs.

Conclusions:

ND is an undesired optical complication of contemporary cataract surgery with an in the bag IOL. Having the optic, or a portion of the optic placed anterior to the anterior capsulotomy appears to prevent ND. The 90S IOL is designed for that purpose. As a proof of concept, the 90S IOL has been completely free of ND to date. However, clinical trials are ongoing as additional design changes are planned to obviate pupil capture.

Financial Disclosure:

gains financially from product or procedure presented