Interactive Case Reports

Maddox rod effect due to aberrations from posterior capsule striae in a pseudophakic patient

Case Report Details

First Author: Z.Ashena UK

Co Author(s):    S. Gallagher   M. Nanavaty                 

Abstract Details

Purpose:

It is known that posterior capsule striae do not affect visual acuity but it is not uncommon for these patients to have optical symptoms in spite of good visual acuity. There is paucity of literature on wavefront aberrometric changes due to posterior capsule striae without significant posterior capsule opacification (PCO) and good visual acuity. We report a pseudophakic case with posterior capsule striae with good visual acuity but symptomatic with ‘bright streaks of light’ since surgery.

Setting:

Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK.

Report of Case:

A 71 year old myopic male underwent routine phacoemulsification and intraocular lens (IOL) insertion. He was unhappy with his visual quality in right eye as he saw ‘streak of bright light’ with his right eye since the surgery, which significantly affected his night time driving. Further questioning about the symptoms revealed that the ‘streaks’ were between his superotemporal and inferonasal field of vision. His best corrected vision was 20/20. Slit lamp examination showed mild peripheral PCO as well as a posterior capsule striae between 2 and 8 O’clock in his right eye. The striae were in line with optic haptic junction. His ‘streaks’ were oriented perpendicularly to these striae. An iTrace aberrometry (Tracey Technologies, Houston) pre and post Nd:YAG laser capsulotomy changed higher order aberration (HOA) from 0.140 µm to 0.091 µm, trefoil (Z3-3) from 0.037 µm to 0.021 µm, trefoil (Z3+3) from 0.083 µm to 0.013 µm, vertical coma (Z3-1) from 0.054 µm to 0.052 µm and horizontal coma ( Z3+1) from 0.067 µm to 0.018 µm leading to complete resolution of symptoms. There were no significant changes in other aberrations up to 6th order.

Conclusion/Take Home Message:

Presence of posterior capsule striae, can cause optical effects which are perpendicular to the orientation of the striae and are due to 3rd order aberrations only. Small changes in the 3rd order higher order aberrations of total eye following Nd:YAG capsulotomy can be enough to resolve the symptoms completely.

Financial Disclosure:

None