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Linaburg TJ, Cui QN, Armenti S. EVALUATION AND MANAGEMENT OF POST-OPERATIVE COMPLICATIONS FOLLOWING CATARACT EXTRACTION AND INTRAOCULAR LENS PLACEMENT. ADVANCES IN OPHTHALMOLOGY AND OPTOMETRY 2024; 9:133-151. [PMID: 39247851 PMCID: PMC11378954 DOI: 10.1016/j.yaoo.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
THIS REVIEW EXPLORES POST-OPERATIVE CHALLENGES ARISING FROM CATARACT SURGERY, INCLUDING INTRAOCULAR LENS (IOL) DECENTRATION OR DISLOCATION, REFRACTIVE SURPRISES, DYSPHOTOPSIAS, AND IOL OPACIFICATIONS. IOL DECENTRATION OR DISLOCATION IS RARE, HIGHLIGHTING THE NEED FOR CAREFUL MANAGEMENT WITH MONITORING, SURGICAL REPOSITIONING OR LENS EXCHANGE TO ACHIEVE OPTIMAL VISUAL OUTCOMES. REFRACTIVE SURPRISES, ATTRIBUTED TO ERRORS IN IOL CALCULATION AND SELECTION, MAY BE MANAGED CONSERVATIVELY OR SURGICALLY, WITH THE MOST ACCURATE RESULTS ACHIEVED BY LASER VISION CORRECTION. POSITIVE AND NEGATIVE DYSPHOTOPSIAS MAY CONTINUE TO BE INTOLERABLE FOR PATIENTS, AND MAY REQUIRE LENS EXCHANGE AS WELL. IOL OPACIFICATIONS VARY BY IOL MATERIAL AND MAY BE VISUALLY SIGNIFICANT, REQUIRING LENS EXCHANGE. WE UNDERSCORE THE IMPORTANCE OF NUANCED MANAGEMENT AND PROVIDING OPTIMAL PATIENT CARE IN THE ABOVE POST-CATARACT SURGERY AND IOL IMPLANTATION COMPLICATIONS.
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Affiliation(s)
- Taylor J Linaburg
- DEPARTMENT OF OPHTHALMOLOGY, SCHEIE EYE INSTITUTE, UNIVERSITY OF PENNSYLVANIA, PHILADELPHIA, PA
| | - Qi N Cui
- DEPARTMENT OF OPHTHALMOLOGY, SCHEIE EYE INSTITUTE, UNIVERSITY OF PENNSYLVANIA, PHILADELPHIA, PA
| | - Stephen Armenti
- DEPARTMENT OF OPHTHALMOLOGY, SCHEIE EYE INSTITUTE, UNIVERSITY OF PENNSYLVANIA, PHILADELPHIA, PA
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Cuevas-Lozano V, Gulias-Cañizo R, Guerrero-Berger O. Modified "C" Haptic Intraocular Lens Orientation and Negative Dysphotopsia. Diagnostics (Basel) 2024; 14:1288. [PMID: 38928703 PMCID: PMC11202647 DOI: 10.3390/diagnostics14121288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Phacoemulsification is the standard of care in cataract surgery in the developed world, with patients having high expectations regarding visual results. Postoperative dissatisfaction due to negative dysphotopsia (ND) ranges from rare to very frequent; its etiology is unclear, and it affects postoperative satisfaction. Since one of the most frequently used strategies to avoid ND is related to intraocular lens (IOL) haptic orientation, we conducted a prospective interventional study that enrolled 197 patients who underwent standard phacoemulsification. All patients had a one-piece hydrophobic acrylic IOL implanted; in one group, the haptics were placed in any meridional axis except inferotemporal (IT) meridians, and in the other group, the IOL was implanted with the haptics in an IT position. Our results showed no statistically significant differences between groups when analyzing the correlation between the position of IOL haptics and the presence of ND in week one and month one. Also, pupillary diameter showed no statistically significant differences between patients with or without ND. Despite some studies claiming that haptic orientation prevents ND, we found that haptic orientation does not correlate with ND incidence and that ND decreases from day 1 to month 1. Our results support previous findings on the decrease in ND over time and that haptic orientation should not be considered an intraoperative strategy to avoid this unwanted phenomenon.
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Affiliation(s)
- Valeria Cuevas-Lozano
- Department of Anterior Segment Surgery, Fundación Hospital Nuestra Señora de la Luz, Mexico City 06030, Mexico
| | - Rosario Gulias-Cañizo
- Centro de Investigación en Ciencias de la Salud, Universidad Anahuac, Mexico City 01840, Mexico
- Centro Oftalmológico Mira, Mexico City 06760, Mexico
| | - Oscar Guerrero-Berger
- Department of Anterior Segment Surgery, Fundación Hospital Nuestra Señora de la Luz, Mexico City 06030, Mexico
- Centro Oftalmológico Mira, Mexico City 06760, Mexico
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Roop P, Nayak S, Kittur A, Roop R, Sharma N. Evaluation of a new device to treat negative dysphotopsia. J Cataract Refract Surg 2024; 50:122-127. [PMID: 37753932 DOI: 10.1097/j.jcrs.0000000000001323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of Negative Dysphotopsia (ND) Ring implantation for treating and preventing ND. SETTING Multicentric tertiary eye hospitals. DESIGN Prospective interventional cohort study. METHODS 22 patients with ND were enrolled. Eyes with other ocular structural pathologies (corneal, macular, optic nerve head, retinal, neuro-ophthalmological) were excluded. In 15 eyes, the ring was implanted to treat ND (therapeutic group), and in 7 eyes, it was implanted during cataract surgery of the fellow eye as a prophylactic measure (prophylactic group) to prevent the occurrence of ND. Preoperative evaluation included video recording of the patients' complaints aside complete eye examination. Postoperatively, patients were interviewed to confirm resolution of complaints related to ND. The intraoperative difficulties and postoperative adverse events were recorded. A minimum follow-up of 1 year was completed for all eyes. RESULTS In the therapeutic group, 14 of 15 eyes (93.3%) patients reported complete resolution of ND on the first postoperative day while 1 patient reported persistence of a smaller and lighter temporal shadow. No ND was reported by any patient in any of the 7 eyes treated prophylactically. No significant adverse intraoperative event was recorded; however, vitreous upthrust was noted in 2 of 22 eyes (9.0%). No permanent drop in visual acuity was recorded in the therapeutic group. CONCLUSIONS ND Ring implantation was an easy, safe, and effective approach for both treating and preventing ND.
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Affiliation(s)
- Prakhyat Roop
- From the Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India (P. Roop, Nayak, Kittur, Sharma); AcuraVision Clinics, Roop Netralaya, Meerut, India (R. Roop)
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Pusnik A, Petrovski G, Lumi X. Dysphotopsias or Unwanted Visual Phenomena after Cataract Surgery. Life (Basel) 2022; 13:53. [PMID: 36676002 PMCID: PMC9866410 DOI: 10.3390/life13010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Dysphotopsias are unwanted visual phenomena that occur after cataract surgery. They represent some of the most common reasons for patient dissatisfaction after uncomplicated surgery for cataract phacoemulsification with in-the-bag intraocular lens (IOL) implantation. Depending on the form of the optical phenomenon and the effect it poses on vision, dysphotopsias are divided into positive and negative type. Positive dysphotopsias are usually described by patients as glare, light streaks, starbursts, light arcs, rings, haloes, or flashes of light. Negative dysphotopsias are manifested as an arc-shaped shadow or line usually located in the temporal part of the visual field, similar to a temporal scotoma. In addition to their different clinical manifestations, positive and negative dysphotopsia also have different risk factors. Even though up to 67% of patients may experience positive dysphotopsia immediately after surgery, only 2.2% of the cases have persistent symptoms up to a year postoperatively. Surgical intervention may be indicated in 0.07% of cases. The incidence of negative dysphotopsias is up to 26% of all patients; however, by one year postoperatively, the symptoms usually persist in 0.13 to 3% of patients. For both types of dysphotopsia, preoperative patients' education, accurate preoperative diagnostics, and use of an appropriate IOL design and material is mandatory. Despite all these measures, dysphotopsias may occur, and when noninvasive measures fail to improve symptoms, a surgical approach may be considered.
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Affiliation(s)
- Ambroz Pusnik
- Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Goran Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
- Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, 21000 Split, Croatia
| | - Xhevat Lumi
- Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Adre E, Tonk R. Positive and Negative Dysphotopsias: Causes, Prevention, and Best Strategies for Treatment. CURRENT OPHTHALMOLOGY REPORTS 2021. [DOI: 10.1007/s40135-021-00278-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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van Vught L, Dekker CE, Stoel BC, Luyten GPM, Beenakker JWM. Evaluation of intraocular lens position and retinal shape in negative dysphotopsia using high-resolution magnetic resonance imaging. J Cataract Refract Surg 2021; 47:1032-1038. [PMID: 33577270 DOI: 10.1097/j.jcrs.0000000000000576] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/26/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE To assess potential relationships of intraocular lens (IOL) position and retinal shape in negative dysphotopsia (ND). SETTING Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands. DESIGN Case-control study. METHODS High-resolution ocular magnetic resonance imaging (MRI) scans were performed in patients with ND and pseudophakic controls, and subsequently used to determine the displacement and tilt of the in-the-bag IOL about the pupil and iris. In addition, anterior segment tomography was used to assess the iris-IOL distance. Furthermore, the retinal shape was quantified from the MRI scans by fitting an ellipse to the segmented inner boundary of the retina. Both the IOL position and retinal shape were compared between groups to assess their potential role in the etiology of ND. RESULTS In total, 37 patients with ND and 26 pseudophakic controls were included in the study. The mean displacement and tilt of the IOL were less than 0.1 mm and 0.5 degrees, respectively, in both groups and all directions. The corresponding mean iris-IOL distance was 1.1 mm in both groups. Neither of these values differed statistically significantly between groups (all P values >.6). The retinal shape showed large variations but was not statistically significantly different between the groups in both the left-right (P = .10) and the anterior-posterior (P = .56) directions. CONCLUSIONS In this study, the in-the-bag IOL position and retinal shape did not statistically significantly differ between patients with ND and the general pseudophakic population. Given the large variation in retinal shape between subjects, however, it could still be an important factor in a multifactorial origin of ND.
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Affiliation(s)
- Luc van Vught
- From the Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands (van Vught, Luyten, Beenakker); Department of Radiology, C.J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, the Netherlands (van Vught, Beenakker); Division of Image Processing (LKEB), Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (Dekker, Stoel)
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Distinct differences in anterior chamber configuration and peripheral aberrations in negative dysphotopsia. J Cataract Refract Surg 2021; 46:1007-1015. [PMID: 32271269 PMCID: PMC8059877 DOI: 10.1097/j.jcrs.0000000000000206] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Clinical evaluations combined with ray-tracing analyses in patients with negative dysphotopsia supported the role of an increased angle κ. Purpose: To provide insights into the anatomical characteristics associated with negative dysphotopsia using quantitative clinical data. Setting: Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands. Design: Case-control study. Methods: Anterior chamber tomography and peripheral aberrometry were measured in 27 pseudophakic patients with negative dysphotopsia and 30 pseudophakic control subjects. Based on these measurements, the total corneal power, anterior chamber depth, pupil location and diameter, iris tilt, and peripheral ocular wavefront up to 30 degrees eccentricity were compared between both groups. In addition, ray-tracing simulations using pseudophakic eye models were performed to establish a connection between these clinical measurements and current hypotheses on the etiology of negative dysphotopsia. Results: Twenty-seven patients with negative dysphotopsia and 25 pseudophakic controls were included in the analysis. The patients with negative dysphotopsia had a smaller (P = .03/P = <.01) and more decentered (P < .01) pupil than that of the pseudophakic controls. In addition, an increased temporal-tilted iris (P < .01) and an asymmetric peripheral aberration profile were observed in patients with negative dysphotopsia, of which the latter was also apparent in several ray-tracing models. The combination of these in vivo results and ray-tracing simulations indicated that patients with negative dysphotopsia had a temporal-rotated eye, which confirmed the hypothesized relation between negative dysphotopsia and an increased angle κ. Conclusions: Patients with negative dysphotopsia had a smaller pupil and an increased angle κ, which made them more susceptible to experiencing a shadow in the temporal visual field.
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EDITOR'S COMMENT. J Cataract Refract Surg 2021; 47:1101-1102. [PMID: 34292902 DOI: 10.1097/01.j.jcrs.0000769520.72406.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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August consultation #4. J Cataract Refract Surg 2021; 47:1098. [PMID: 34292897 DOI: 10.1097/01.j.jcrs.0000769500.27195.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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August consultation #2. J Cataract Refract Surg 2021; 47:1096-1097. [PMID: 34292895 DOI: 10.1097/01.j.jcrs.0000769492.34665.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sharma P, Kalia S, Chouhan JK. Incidence and causes of negative dysphotopsia after uncomplicated cataract surgery - A randomized clinical trial. Indian J Ophthalmol 2021; 69:1786-1791. [PMID: 34146029 PMCID: PMC8374810 DOI: 10.4103/ijo.ijo_3751_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The purpose of this study is to find incidence of negative dysphotopsia (ND) in eyes undergoing clear corneal phacoemulsification and identify its causes including corneal wound hydration and type of intraocular lens (IOL). Methods: In this randomized clinical trial, consenting adult patients undergoing phacoemulsification were randomized to receive a hydrophobic (Alcon Acrysof® SN60WF) or a hydrophilic acrylic IOL (CT Asphina® 603P, Carl Zeiss Meditec) in a 1:1 ratio. At time of surgery, eyes were again randomized in 1:1 fashion to receive stromal wound hydration or not (n = 80 each in four groups). Primary outcome measure was the incidence of ND between eyes receiving stromal hydration versus no hydration. Those with ND were observed for 5 years after surgery. Results: Of the 320 eyes, 29 (9.06%) reported ND of which 24 (83%) were transient. Eyes with wound hydration had significantly higher proportion of ND (n = 21/160, 13%) compared to no hydration (n = 8/160, 5%) (P = 0.01). Additionally, eyes with wound hydration were three times more likely to experience ND (odds ratio = 3.29, 95% CI = 1.3–8.2, P = 0.01). Majority of eyes (20/21, 95%) with ND after hydration had it transiently while half (4/8, 50%) of those with ND without wound hydration had it persistently at 6 weeks (P < 0.001) and continued to experience ND for 5 years but did not request intervention. Conclusion: ND occurred in 9% cases with majority being transient. Corneal wound hydration led to significant higher likelihood of experiencing transient ND. Those with persistent ND for more than 6 weeks (1.5%) continue to experience ND for at least 5 years.
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Affiliation(s)
- Pankaj Sharma
- Upgraded Department of Ophthalmology, Sawai Man Singh (SMS) Medical College, Jaipur, Rajasthan, India
| | - Sonal Kalia
- Upgraded Department of Ophthalmology, Sawai Man Singh (SMS) Medical College, Jaipur, Rajasthan, India
| | - Jugal Kishor Chouhan
- Upgraded Department of Ophthalmology, Sawai Man Singh (SMS) Medical College, Jaipur, Rajasthan, India
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Feng Y, Weinlander E, Shah M. Targeted Lens Pitting to Treat Negative Dysphotopsia. J Refract Surg 2021; 37:212-214. [PMID: 34038305 DOI: 10.3928/1081597x-20210115-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a patient with negative dysphotopsia who underwent a novel non-invasive technique that uses the Nd:YAG laser to induce nasal light scattering through targeted lens pitting. METHODS Case report. RESULTS Symptoms of negative dysphotopsia resolved after targeted lens pitting. CONCLUSIONS Targeted lens pitting with Nd:YAG laser is a potential technique that may help treat negative dysphotopsia in a manner that preserves intraocular anatomy. Further study is warranted to explore targeted lens pitting in both patients with and without prior retinal surgery as a treatment for negative dysphotopsia. [J Refract Surg. 2021;37(3):212-214.].
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Masket S, Fram NR. Pseudophakic Dysphotopsia: Review of Incidence, Cause, and Treatment of Positive and Negative Dysphotopsia. Ophthalmology 2020; 128:e195-e205. [PMID: 32800744 DOI: 10.1016/j.ophtha.2020.08.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 11/16/2022] Open
Abstract
We reviewed the literature concerning positive dysphotopsia (PD) and negative dysphotopsia (ND) regarding cause, incidence, and clinical and surgical management. In addition, we summarized our surgical experience in managing dysphotopsia. A PubMed review, limited to English language articles, yielded 149 citations; multifocal (diffractive optic) and phakic intraocular lens (IOL) dysphotopsia were excluded. Overall, 39 articles were determined to be relevant for the objectives of this investigation. Regarding PD, 7 articles corroborated that the cause of PD is related primarily to internal reflection of oblique light rays that strike the square (truncated) edge of the IOL and are reflected onto the retinal surface. No round-edged foldable IOLs are available in the United States at this time, although IOLs modified with a round anterior edge and square posterior edge show a trend toward decreased incidence of PD. High index of refraction (I/R), surface reflectivity, and IOL optic design are additional causative factors for PD. Regarding the authors' surgical experience, changing the optic material to have a lower I/R improved PD symptoms in the large majority of patients. The cause of ND seems to be multifactorial and less well understood, with some disparity between clinical and laboratory findings. Four articles that explore using ray-tracing optical modeling suggest an "illumination gap," in which some temporally incident light rays to the nasal retina pass anterior to the IOL and some are refracted posteriorly by the IOL, resulting in a gap and resultant temporal shadow. However clinically, ND is associated invariably with well-centered in-the-bag IOLs. Other implicating factors include nasal anterior capsule override, haptic orientation, large-angle κ value, and high hyperopia. Persistent ND has been treated successfully or reduced with reverse (anterior) optic capture, sulcus IOL placement, piggyback IOLs, and neodymium:yttrium-aluminum-garnet nasal capsulectomy. Two articles reference a new optic edge designed to capture the anterior capsulotomy, mimicking reverse optic capture. Persistent dysphotopsia after cataract surgery is a significant cause for patient dissatisfaction. The cause and management of both ND and PD are of significance, and new IOL designs and alternative surgical strategies may help to mitigate these unintended side effects of IOL implantation.
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Affiliation(s)
- Samuel Masket
- Advanced Vision Care, Los Angeles, California, and Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Nicole R Fram
- Advanced Vision Care, Los Angeles, California, and Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
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Erie JC, Simpson MJ, Bandhauer MH. A modified intraocular lens design to reduce negative dysphotopsia. J Cataract Refract Surg 2019; 45:1013-1019. [DOI: 10.1016/j.jcrs.2019.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/27/2018] [Accepted: 01/15/2019] [Indexed: 12/25/2022]
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Effect of a sulcus-fixated piggyback intraocular lens on negative dysphotopsia: Ray-tracing analysis. J Cataract Refract Surg 2019; 45:443-450. [DOI: 10.1016/j.jcrs.2018.10.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 11/21/2022]
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Affiliation(s)
- Samuel Masket
- Advanced Vision Care, Stein Eye Institute, Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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Makhotkina NY, Nijkamp MD, Berendschot TT, van den Borne B, Nuijts RM. Effect of active evaluation on the detection of negative dysphotopsia after sequential cataract surgery: discrepancy between incidences of unsolicited and solicited complaints. Acta Ophthalmol 2018; 96:81-87. [PMID: 28661569 DOI: 10.1111/aos.13508] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/20/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the incidence of negative dysphotopsia after sequential cataract surgery. METHODS Retrospective cohort study. The incidence of negative dysphotopsia was assessed by retrospective reviewing of medical records and interviews with patients between 2 and 4 months after sequential cataract surgery. Inclusion criteria were uncomplicated surgery, postoperative corrected distance visual acuity (CDVA) ≥20/25 Snellen and the absence of ocular comorbidity. The majority of intra-ocular lens (IOL) implants were one-piece AcrySof SN60WF (161 eyes). Other IOLs (29 eyes) were toric (SN6AT3-6), spherical (SN60AT), three-piece (MN60MA) and multifocal (ReSTOR SN6AD1, PanOptix TFNT00 and Finevision Micro F trifocal). RESULTS The study population was comprised of 95 patients with a mean age of 72 ± 10 years. Unsolicited complaints of negative dysphotopsia were reported by eight patients (8%), and two of them had a resolution of symptoms within 1 month of follow-up. Eighteen patients (19%) reported negative dysphotopsia at the time of the interview. Two patients reported bothersome negative dysphotopsia, and one of them was successfully treated with implantation of a supplementary IOL in the ciliary sulcus. Patients with negative dysphotopsia were younger than patients without dysphotopsia (p = 0.045) and had shorter axial eye length (p = 0.04), a tendency for higher IOL power (p = 0.09) and a higher CDVA (p = 0.001). CONCLUSION The incidence of unsolicited negative dysphotopsia after sequential cataract surgery appears to be a substantial underestimation of complaints identified in active interviewing. Although symptoms are not bothersome in the majority of cases, some patients with undiagnosed severe negative dysphotopsia may benefit from reassurance or secondary treatment.
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Affiliation(s)
- Natalia Y. Makhotkina
- University Eye Clinic; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Marjan D. Nijkamp
- Faculty of Psychology and Educational sciences; Open University of the Netherlands; Heerlen The Netherlands
| | | | - Bart van den Borne
- Department of Health Promotion; University of Maastricht; Maastricht The Netherlands
| | - Rudy M.M.A. Nuijts
- University Eye Clinic; Maastricht University Medical Centre; Maastricht The Netherlands
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Effect of supplementary implantation of a sulcus-fixated intraocular lens in patients with negative dysphotopsia. J Cataract Refract Surg 2018; 44:209-218. [DOI: 10.1016/j.jcrs.2017.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/14/2017] [Accepted: 11/30/2017] [Indexed: 11/20/2022]
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Surgical management of negative dysphotopsia. J Cataract Refract Surg 2018; 44:6-16. [DOI: 10.1016/j.jcrs.2017.10.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/11/2017] [Accepted: 10/20/2017] [Indexed: 11/20/2022]
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Abstract
The appearance of a dark shadow in the temporal periphery, otherwise known as negative dysphotopsia, continues to be a problem for some patients after routine uncomplicated cataract surgery. Etiologies include type and design of intraocular lens (IOL), anatomical features and dimensions of the eye, pupil size, angle kappa, relationship of the optic to the anterior capsule, and the position of the optic/haptic junction of the IOL. Although the primary etiology remains controversial, it is clear that the cause is multifactorial. All of the factors should be considered when attempting to prevent or treat this phenomenon.
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Affiliation(s)
- Ivayla I Geneva
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Bonnie A Henderson
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA
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Palkovits S, Findl O. Pseudophake Dysphotopsien. SPEKTRUM DER AUGENHEILKUNDE 2016. [DOI: 10.1007/s00717-016-0313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Negative dysphotopsia: A perfect storm. J Cataract Refract Surg 2016; 41:2291-312. [PMID: 26703307 DOI: 10.1016/j.jcrs.2015.09.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 05/16/2015] [Accepted: 05/28/2015] [Indexed: 11/20/2022]
Abstract
UNLABELLED The objective of this review was to provide a summary of the peer-reviewed literature on the etiologies of negative dysphotopsia that occurs after routine cataract surgery. A search of PubMed, Google Scholar, and Retina Medical identified 59 reports. Negative dysphotopsia has been associated with many types of intraocular lenses (IOLs), including hydrophobic and hydrophilic acrylic, silicone, and 1-piece and 3-piece designs. Proposed etiologies include edge design, edge smoothness, edge thickness, index of refraction of the IOL, pupil size, amount of functional nasal retina, edema from the clear corneal incision, distance between the iris and IOL, amount of pigmentation of the eye, corneal shape, prominent globe and shallow orbit, and interaction between the anterior capsulorhexis and IOL. Treatments include a piggyback IOL, reverse optic capture, dilation of the pupil, constriction of the pupil, neodymium:YAG capsulotomy of the nasal portion of the anterior capsule, IOL exchange with round-edged optics, and time alone. This review summarizes the findings. FINANCIAL DISCLOSURE Dr. Henderson is a consultant to Alcon Laboratories, Inc., Abbott Medical Optics, Inc., Bausch & Lomb, and Genzyme Corp. Neither author has a financial or proprietary interest in any material or method mentioned.
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Current Theories and Methods for Managing Negative Dysphotopsia. Int Ophthalmol Clin 2016; 56:107-16. [PMID: 27257726 DOI: 10.1097/iio.0000000000000123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Is the Memory Effect of the Blind Spot Involved in Negative Dysphotopsia after Cataract Surgery? J Ophthalmol 2015; 2015:786579. [PMID: 26425353 PMCID: PMC4575743 DOI: 10.1155/2015/786579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/24/2015] [Accepted: 08/05/2015] [Indexed: 11/18/2022] Open
Abstract
We present novel clinical observations on negative dysphotopsia (ND) in eyes that have undergone cataract surgery. In the past, shadow effects were alleged to be located in the far peripheral temporal visual field 50° to 100° away from the optical axis. In a small series of eight patients we found evidence of photic effects, described by the patients as shadows in the periphery that were objectively located much more centrally. In all cases, we could find an association of these phenomena with the blind spot. We hypothesize that the memory effect of the blind spot which is dislocated and changed in magnification due to replacement of the crystalline lens could be one determinant for pseudophakic ND. The scotoma of the optic nerve head and the main arteries and veins of the phakic eye are displaced in the pseudophakic eye depending on the specific characteristics and position of the intraocular lens within the eye.
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Simpson MJ. Vignetting and negative dysphotopsia with intraocular lenses in "far peripheral vision". JOURNAL OF THE OPTICAL SOCIETY OF AMERICA. A, OPTICS, IMAGE SCIENCE, AND VISION 2015; 32:1672-1677. [PMID: 26367435 DOI: 10.1364/josaa.32.001672] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
At very large visual angles, vignetting can occur at the edge of an intraocular lens (IOL), because it is much smaller than the natural crystalline lens that it replaces. Ray trace calculations show that, by 80-90 deg of input visual angle, it is possible that about half the light is no longer focused by the IOL. This may create curved, peripheral, shadowlike regions, which are a clinical characteristic of negative dysphotopsia. The imaging characteristics for this "far peripheral vision" region are different from those of a phakic eye, whether or not negative dysphotopsia is experienced.
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Makhotkina NY, Berendschot TTJM, Beckers HJM, Nuijts RMMA. Treatment of negative dysphotopsia with supplementary implantation of a sulcus-fixated intraocular lens. Graefes Arch Clin Exp Ophthalmol 2015; 253:973-7. [PMID: 25947640 PMCID: PMC4445254 DOI: 10.1007/s00417-015-3029-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/09/2015] [Accepted: 04/20/2015] [Indexed: 11/06/2022] Open
Abstract
Purpose Our aim was to evaluate the resolution of negative dysphotopsia after supplementary implantation of a sulcus-fixated intraocular lens (IOL). Methods This was a retrospective case series. Patients with severe negative dysphotopsia were treated with supplementary implantation of the Rayner Sulcoflex Aspheric (653 L) IOL. Primary outcome measurements were subjectively reported complaints of dysphotopsia, best corrected distance visual acuity (CDVA), iris-IOL distance, anterior chamber depth (ACD) and volume (ACV), angle opening distance and trabecular-iris space area at 500 and 750 μm. Results A Rayner Sulcoflex IOL was implanted in seven patients (nine eyes) with negative dysphotopsias. Symptoms resolved completely in six eyes, partially in one eye and remained unchanged in two eyes. We did not find any significant changes in CDVA. Angle opening distance, ACD, ACV and iris-IOL distance reduced significantly after Sulcoflex IOL implantation. Conclusions Supplementary implantation of a Sulcoflex IOL can successfully treat negative dysphotopsia. The decrease in anterior segment dimensions in combination with the displacement of light rays by the rounded edges of a Sulcoflex IOL may contribute to the resolution of symptoms.
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Affiliation(s)
- Natalia Y Makhotkina
- University Eye Clinic, Maastricht University Medical Centre, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands,
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Primary reverse optic capture with implantation of capsular tension ring to prevent pseudophakic negative dysphotopsia. J Cataract Refract Surg 2015; 41:891-2. [PMID: 25840311 DOI: 10.1016/j.jcrs.2014.11.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 11/25/2014] [Indexed: 11/24/2022]
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Masket S, Fram NR. Sulcus-fixated IOLs for negative dysphotopsia. J Cataract Refract Surg 2015; 41:478. [PMID: 25661151 DOI: 10.1016/j.jcrs.2014.12.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Indexed: 10/24/2022]
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Simpson MJ. Double image in far peripheral vision of pseudophakic eye as source of negative dysphotopsia. JOURNAL OF THE OPTICAL SOCIETY OF AMERICA. A, OPTICS, IMAGE SCIENCE, AND VISION 2014; 31:2642-2649. [PMID: 25606753 DOI: 10.1364/josaa.31.002642] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Some intraocular lens (IOL) patients report seeing "dark shadows" at visual angles that are larger than 60°-70°. Raytrace models of the pseudophakic eye show that light starts to miss the IOL at large visual angles because the implant diameter of about 6 mm is much smaller than the natural crystalline lens diameter of 9.5 mm. This light forms a second displaced image on the peripheral retina. To evaluate the appearance of the image, raytrace software was used to image an illuminated window onto the highly curved retina, and a method was developed to project the image back to object space for evaluation on a flat surface. Only a single schematic eye was evaluated monochromatically and the low resolution of the peripheral retina was not modeled, but the simulated images depict a shadow-like phenomenon at similar visual angles to reports of "negative dysphotopsia."
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Burke TR, Benjamin L. Sulcus-fixated intraocular lens implantation for the management of negative dysphotopsia. J Cataract Refract Surg 2014; 40:1469-72. [DOI: 10.1016/j.jcrs.2013.11.037] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/21/2013] [Accepted: 11/19/2013] [Indexed: 12/01/2022]
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Kim JA, Ha AN, Kwon JW, Wee WR, Han YK. Clinical Characteristics and Patient's Satisfaction in Pseudophakic Negative Dysphotopsia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.5.669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jeong Ah Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Ah Nul Ha
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Ji Won Kwon
- Department of Ophthalmology, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
| | - Won Ryang Wee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Young Keun Han
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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