July consultation #5.


This patient represents one of the most frustrating problems for cataract surgeons because she has a beautiful surgical outcome from a technical perspective but has debilitating dysphotopsia symptoms. In my experience, patients with the most troublesome negative dysphotopsias are always those with perfect IOL centration and uniform anterior capsule overlap of the optic. The various treatments that have been documented to alleviate negative dysphotopsia include IOL exchange, secondary piggyback IOL placement, and reverse optic capture, where the IOL optic is intentionally displaced in front of the anterior capsule. This patient presents a few unique problems. She had previous hyperopic LASIK, which increased the already prolate cornea and can induce increased negative asphericity. After uneventful cataract surgery with spherical IOL placement, she had unrelenting negative dysphotopsia symptoms and had that IOL exchanged for a collagen copolymer plate IOL. This IOL has a low index of refraction (1.442), which should reduce the chance of unwanted optical aberrations, such as dysphotopsia. However, the negative dysphotopsia persisted in this patient after placement of the collagen copolymer IOL. The UBM of this patient shows the IOL is in a fairly anterior position, which would preclude safe placement of a piggyback IOL in the ciliary sulcus. Although this patient has already had cataract surgery and an IOL exchange, her corneal endothelium is normal and the anterior segment of the eye is quiet and stable. I would recommend a second IOL exchange to place an AQ2010V IOL in the capsular bag. This IOL is made of silicone and is one of the few IOLs on the market with a truly round optic edge. The round edge combined with the low index of refraction make this IOL a good choice for minimizing the risk for dysphotopsia. In addition, because this patient has had hyperopic LASIK, this spherical IOL is optimal for counteracting the induced negative asphericity of the cornea. I have used the AQ2010V as my IOL of choice for treating negative dysphotopsia. I have explanted 32 IOLs for negative dysphotopsia symptoms since March 2008d26 SN60WF (Alcon Laboratories, Inc.), 1 SN6AD1 (Alcon Laboratories, Inc.), 2 SN6AT (Alcon

DOI: 10.1016/j.jcrs.2013.05.008

Cite this paper

@article{Holladay2013JulyC, title={July consultation #5.}, author={Jack T . Holladay}, journal={Journal of cataract and refractive surgery}, year={2013}, volume={39 7}, pages={1125-6} }