Surgical management of negative dysphotopsia

Session Details

Session Title: Presented Poster Session: Cataract Surgery Outcomes

Session Date/Time: Tuesday 08/09/2015 | 09:30-11:10

Paper Time: 09:40

Venue: Poster Village: Pod 1

First Author: : S.Masket USA

Co Author(s): :    N. Fram              

Abstract Details

Purpose:

Negative Dysphotopsia (ND) is an enigmatic complication of otherwise uncomplicated cataract surgery. Although symptoms improve over time in the majority of cases, some patients remain very dissatisfied and request remediation. Non-surgical means are generally unsuccessful. The purpose of this investigation is to consider the etiology of the condition and the resultant surgical options. Evidence indicates that ND may be induced by any intraocular lens (IOL) that is capsule bag placed with an overlying anterior capsulotomy. Surgical strategies that elevate the IOL optic above the anterior capsule are theoretically curative. The current investigation explores remedial and prophylactic surgical options.

Setting:

Advanced Vision Care, Private Practice, LA, USA

Methods:

34 patients with chronic ND were considered for corrective surgery and had IOL exchange (7 eyes), secondary reverse (anterior) optic capture (16 eyes), or “Piggy-Back” IOL implantation (11 eyes). Patients with chronic ND in one eye had primary reverse optic capture for prophylaxis in the second eye (11 eyes). An additional group of patients (20 eyes) had primary IOL implantation with a novel lens implant (Morcher 90S) designed to prevent ND. A simple questionnaire was used to determine patient symptoms regarding dysphotopsia.

Results:

Of the 7 patients who had IOL exchange, 3 had bag/bag exchange with a lens of different design: 0/3 had improvement in symptoms whereas 3/4 who had bag/sulcus exchange were improved. Secondary reverse optic capture improved or alleviated 15/16 patients and “Piggy-Back” secondary implantation was successful in 8/11 eyes. 10/11 eyes with primary revers optic capture were free of ND. None of the patients implanted with the Morcher 90S IOL had ND.

Conclusions:

The results of the investigation suggest that patients with chronic ND can be helped with secondary surgery. Secondary (anterior) reverse optic capture was most beneficial. Moreover, none of the patients with the Morcher 90S IOL experienced ND at any time after surgery. These findings concur with the suggestion that ND can be alleviated or prevented when the IOL optic (in part or whole) sits anterior to the edge of the anterior capsulotomy.

Financial Interest:

One of the authors gains financially from product or procedure presented