Cases of replacing diffractive bifocal intraocular lens with extended depth of focus intraocular lens due to waxy vision

Purpose To investigate the postoperative course of patients who explanted a diffractive bifocal intraocular lens (IOL) due to waxy vision and implanted with an extended depth of focus IOL. Methods This study evaluated 29 eyes of 25 patients who underwent diffractive bifocal IOL explantation followed by TECNIS Symfony® implantation because of dissatisfaction due to waxy vision at the Takabatake West Eye Clinic between January 2018 and November 2019. The indication criteria for this surgery were patients with uncorrected distance visual acuity of 0.05 logMAR or better, without eye diseases that may affect visual function, and no dissatisfactions about photic phenomena. We investigated patient demographics, uncorrected and corrected visual acuity, manifest refraction, contrast sensitivity, subjective symptoms, time to IOL explantation, explanted IOL type, and spectacle independence. Results The time to the IOL exchange after the initial IOL implantation was 55.3 ± 50.4 days (range: 14–196 days). The logMAR corrected distance visual acuity before and after IOL exchange were −0.13 ± 0.06 and −0.14 ± 0.06, respectively (p = 0.273). After IOL exchange surgery, the area under log contrast sensitivity function increased significantly from 1.07 ± 0.12 to 1.21 ± 0.12 (p < 0.001), and the waxy vision symptoms improved. The spectacle independence rate at the last visit was 88.0%. Conclusion For patients who complain of waxy vision despite good visual acuity after diffractive bifocal IOL implantation, exchange to extended depth of focus IOL was considered one of the useful surgical options.

The influence of intraocular lens dislocation surgical correction method on corneal endothelium

BACKGROUND:Intraocular lens (IOL) dislocation is a rare but serious complication of surgical treatment of patients with cataract. Among the factors contributing to its development, the main ones are pseudoexfoliation syndrome (PEX), high axial myopia, chronic uveitis, history of eye injury and age. There is no universal IOL dislocation correction technique. PURPOSE:To evaluate the impact on corneal endothelium of two different methods of IOL dislocation correction: IOL repositioning with transscleral suture fixation or IOL exchange to iris-claw one. MATERIALS AND METHODS:Within the study, 78 patients were examined and operated. All patients were divided into two groups: in the first group, IOL was repositioned with transscleral suture fixation, and in the second group IOL was exchanged to iris-claw IOL. Groups were equal by gender and age. Key estimated indicators were endothelial cell density and coefficient of variation reflecting the degree of polymegatism. RESULTS:Endothelial cell density was significantly lower both before surgery and at any term after it, in the group with IOL exchange, and coefficient of variation was significantly higher in the group with IOL exchange throughout this study. CONCLUSION:The choice of technique for IOL dislocation correction is the basis of success in surgical treatment. Certain preoperative examination data should be definitely considered, including the degree of dislocation, IOL type, IOP level, endothelial cell density and presence of concomitant ocular conditions.

Outcomes of Re-fixation after the First Intraocular Lens Scleral Fixation

Purpose: To investigate the outcomes of re-fixation after the first intraocular lens (IOL) scleral fixation. Methods: We retrospectively reviewed the charts of patients who underwent second IOL scleral fixation and vitrectomy for dislocation of IOL after the first IOL scleral fixation. We compared the best-corrected visual acuity (BCVA) and spherical equivalent (SE) after 1 month of the first and second surgery, and noted the complications. Results: We included 21 eyes that underwent second IOL scleral fixation: 13 eyes (61.9%) with IOL exchange and eight (38.1%) with one-haptic fixation. Mean BCVAs (LogMAR) were 0.17 ± 0.25 and 0.11 ± 0.23 after the first and second surgery, respectively (<i>p</i> = 0.073); mean SEs were -0.94 ± 1.69 and -0.58 ± 1.46 diopters after the first and second surgery, respectively (<i>p</i> = 0.076). Postoperative complications occurred in eight eyes (38.1%), including temporarily increased intraocular pressure and suture knots exposure. However, none of the complications required re-operation. Conclusions: The outcomes of primary and secondary IOL fixation were similar, and there were no serious complications of the second surgery.

Tertiary Cataract- A Rare Postoperative Complication after Cataract Surgery: A Case Study

Introduction: IOL opacification is a rare and serious complication of post operative diminution of vision with the only effective treatment being lens explantation and replacement, preferably involving lens of different material1. Following cataract surgery, it can occur anytime varying from months to years after the surgery. Case Report: A 57-years-old male presented with chief complaints of left eye diminution of vision since 2 years which was painless and progressive. Patient had undergone both eyes cataract surgery 4 years back elsewhere. He was a known case of Ischemic Heart Disease on treatment. On examination, his best corrected visual acuity (BCVA) was 6/9 in right eye and 6/36 in left eye. On slit light examination, there was presence of white pupillary reflex in left eye giving appearance of white cataract. On dilated examination, both eyes were found to be pseudophakic with left eye having posterior chamber opacified foldable Intra Ocular Lens and posterior segment details in left eye were not visible. B Scan was done and noted to be normal.He was posted for Left eye IOL (Intra Ocular Lens) exchange with rigid IOL Implantation with surgical capsulotomy after which his vision improved. Conclusion: Cases of opacified Intraocular lenses if visually significant require IOL exchange procedure for treatment which is associated with good visual prognosis. Key words: Pseudophakia, Intra Ocular Lens (IOL), Opacified IOL, Acrylic, Hydrophilic, Hydrophobic.

Multifocal IOL Explantation in Patients with Opaque Lentis after Refractive Lens Exchange

Purpose We describe the outcomes of intraocular lens (IOL) explantation in a cluster of opaque multifocal Lentis LS-313 following refractive lens exchange (RLE). Methods Single-centre, single-surgeon, retrospective case series. Results The study enrolled 10 eyes of 10 patients, 6 male and 4 female. All patients had uneventful RLE with multifocal IOL implantation. The mean patient age at the time of RLE was 53 years ± 2.52 (SD). Two eyes had YAG laser capsulotomy prior explantation. The mean interval between the initial RLE and IOL explantation was 5.4 years ± 1.4 (SD). IOL exchange was performed in all eyes in one procedure. Five eyes had in the bag hydrophobic acrylic IOL (3 multifocal and 2 monofocal) three eyes had 3-piece hydrophobic acrylic IOL in the ciliary sulcus and two had an anterior chamber IOL. Intraoperatively one patient had weak zonules and two patients had zonular dehiscence and required anterior vitrectomy. The mean preoperative CDVA was 0.25 ± 0.15 (SD) logMAR and at the final follow-up, improved to 0.00 ± 0.07 (SD) logMAR (p < 0.01). Light microscopy with von Kossa stain confirmed IOL calcification. No postoperative complications were recorded. Conclusions IOL exchange appears to be a feasible and safe surgical option for multifocal IOL opacification. However, patients must be warned of additional intraoperative risks including zonular dialysis, vitreous loss, retinal detachment and need for potential ACIOL with its associated sequel of complications. Moreover, YAG laser capsulotomy should be considered carefully as increases the chances of intraoperative complications and restricts the surgical options of secondary IOL insertion, including in-the-bag IOL exchange with MFIOL.

Multifocal Intraocular Lens Exchange in Patients with Ocular Comorbidities: Indications and Outcomes

Purpose: To investigate all cases of multifocal intraocular lens (MFIOL) exchange, with specific focus on indications for exchange and evaluation of postoperative outcomes, in a tertiary care, multi-specialty ophthalmology practice.Setting/Venue: Academic Referral Center/Cleveland Clinic Abu Dhabi – Abu Dhabi, United Arab EmiratesMethods: This retrospective case series identified all patients that presented to a large academic practice over a 4-year period that were intolerant to MFIOL technology and thus required intraocular lens (IOL) exchange. All patients reported poor vision despite correction of reversible ocular comorbidities, including dry eye and residual refractive error. Outcomes reviewed include subjective visual complaints, IOL-type, visual acuity, refractive error, ocular comorbidities, and surgical outcomes. Endpoints examined include mean uncorrected distance visual acuity (UDVA), mean corrected distance visual acuity (CDVA), mean refractive spherical equivalent (MRSE), and residual refractive astigmatism. Results: Six eyes of five patients required MFIOL exchange. All IOL’s exchanged were trifocal IOL’s. IOL exchange occurred between 6 to 72 months following primary phacoemulsification. Each patient had multiple ocular comorbidities, ranging from keratoconjunctivitis sicca to longstanding intermediate uveitis and macular pathology. Postoperatively, subjective visual complaints resolved in all patients. Objective mean changes in UDVA, CDVA, MRSE and residual astigmatism were not statistically significant. Conclusion: Thorough preoperative evaluation is required prior to MFIOL placement in order to rule out ocular comorbidities that may impair visual quality. In patients with MFIOL intolerance due to irreversible ocular comorbidities, IOL exchange to a monofocal IOL is safe, effective, and results in subjective improvement in vision.