Posters

Postoperative refractive surprise due to manufacturing defect of customised toric intraocular lens

Poster Details

First Author: M.Bhattacharjee INDIA

Co Author(s):    G. Chandrashekar   V. Mohite   S. Agarwala   A. Mahindrakar           

Abstract Details

Purpose:

Postoperative refractive surprises are commonly due to switching of intraocular lens(IOL), wrong IOL power calculation or flipping of IOL while inserting. The purpose of our report is to show that post operative refractive surprise can be due to manufacturing defect in the IOL.

Setting:

Single case report wherein cataract with astigmatism was treated with customised toric IOL.

Methods:

Preoperative workup for the left eye cataract of a  patient was done including vision, intraocular pressure, refraction, slit lamp and fundus examination followed by optical biometry with Barrett's calculator. A customised toric(CTIOL) IOL was placed in the bag after an uneventful surgery. CTIOLs are IOLs which are customised  for the diopter and axis of astigmatism correction so that no rotation is required and IOL can be placed at 0-180 degree axis. They have a customised optic size and overall length for that particular patient unlike other commercially available toric IOLs which have a fixed overall length.

Results:

Preoperative toricity observed was 1.77 at 176 degree. One week postoperatively a refractive surprise of -3.00 degrees cylinder at 90 degree noticed. A detailed study of the operation theatre log showed no flipping, switching of IOL or wrong IOL power calculation. After detailed evaluation and repeat biometry the decision to explant was made. The IOL was explanted and a non customised toric IOL was aligned to the axis originally targeted by the toric calculator. Explanted IOL was sent to the manufacturer who confirmed the wrong toricity of the IOL. Final refraction after three months revealed -0.5 ds, 6/6. No astigmatism.

Conclusions:

Most common cause of postoperative refractive surprise is switching of IOL between patients, wrong IOL power calculation or flipping of IOL during the surgery. However, rare causes like manufacturing defects should also be considered when all other reasons have been ruled out.

Financial Disclosure:

None