Posters

Persistent poor vision in dim illumination, after the implantation of Xtra focus small aperture IOL(Morchers GMBH)

Poster Details

First Author: P.Agarwal UAE

Co Author(s): S. Navon                    

Abstract Details

Purpose:

To demonstrate significantly poor vision in dim illumination almost to the magnitude of bare perception of large objects and hand movements close to face due to pinhole effect of xtra focus small aperture IOL.

Setting:

Cleveland Clinic Abu Dhabi

Methods:

21-year-old  presents to us with complaints of blurred vision and photophobia in the left eye with an uncorrected visual acuity of 20/100 improving to 20/30 with pinhole and diagnostic rigid gas permeable lens trial. He had a history of trauma with subsequent cataract extraction and traumatic mydriasis.  Ultrasound bio microscopy revealed adequate anterior chamber depth of 3.4 mm and the pre-existing IOL in the bag.  Corneal topography revealed irregular astigmatism of 2.15dioptres .The total higher-order corneal aberrations were 2.3 µ and coma was 0.77 µ. Under topical and monitored anaesthesia  Xtra focus pinhole IOL was implanted in the ciliary sulcus

Results:

Postoperatively 1 week left eye uncorrected visual acuity improved to 20/30 intermediate uncorrected visual acuity improved to 20/40 and uncorrected near visual acuity improved to J4 .The glare and photophobia resolved completely nevertheless the patient was excessively bothered by the substantial reduction in vision in dim illumination. The visual acuity was limited to bare perception of objects and hand movements close to face in scotopic conditions with illumination less than 50 lux.  Under increased illumination of 100-500 lx simulating normal office lighting conditions the vision was normal.The patient preferred to have his IOL explanted despite good visual outcome.

Conclusions:

• This case highlights the importance of meticulous counselling preoperatively for any patient undergoing small apertures implants namely,Xtra focus pinhole IOL and IC 8 implantation. • It may be wise to counsel the patient preoperatively about the possible compromised vision in dim illumination.  • A trial of pinhole contact lens can be employed to simulate the postoperative visual quality at different illumination’s by varying the room lightning. This helps to set forth the right expectations postoperatively.

Financial Disclosure:

None