Secondary positioning of rotationally asymmetric refractive multifocal intraocular lens in a patient with glaucoma:A case report

BACKGROUND Asymmetric multifocal intraocular lenses(IOLs)are now widely used in the modern cataract surgery,providing a good level of visual performance over a range of distances and high postoperative patient satisfaction.We report a case of improved visual quality after shifting the near segment of an asymmetrical multifocal IOL to the superotemporal placement in the dominant eye of a glaucoma patient.CASE SUMMARY A 72-year-old woman with bilateral glaucoma underwent phacoemulsification in the dominant eye(left eye)with implantation of an asymmetrical multifocal IOL.Postoperative uncorrected distance visual acuity(UDVA)was 0.0 logMAR(20/20 Snellen)and uncorrected near visual acuity(UNVA)was 0.1 logMAR(20/25 Snellen).Two weeks later,the patient presented to our clinic with decreased vision due to migration of lens epithelial cells to IOL anterior surface and edema of corneal endothelial cells.Anterior capsule polishing and superotemporal placement of near segment[+3.00 diopter(D)addition(add)]of IOL were performed.As a result,UDVA at the first week and first year after reposition was 0.0 logMAR(20/20 Snellen),and compared with 0.3 logMAR(20/40 Snellen)in the first week,the UNVA was improved to 0.0 logMAR(20/20 Snellen)one year after surgery.CONCLUSION The postoperative inflammatory reaction and lens epithelial cells proliferation were obvious in this glaucoma patient.Capsule polishing and rotation of the lens were beneficial to the patient,which not only enhanced the patient's vision,but also improved the patient's satisfaction.Therefore,glaucoma patients need to be cautious of implanting multifocal IOLs.Placement of a near segment of an asymmetrical multifocal IOL in the dominant eye should be performed on an individual basis.

Comparison of preoperative simulated and postoperative real safety distances using anterior segment OCT in patients with phakic IOL according to iris configuration

AIM:To compare the simulated safe distance(SSD)preoperatively versus real safe distance(RSD)postoperatively in patients with iris-claw phakic intraocular lens(p IOL)implantation according to iris configuration.METHODS:Totally 60 eyes of 60 patients underwent p IOL implantation for surgical correction of myopia.Anterior chamber depth(ACD)was measured with the IOLMaster 700,and nasal and temporal safety distances(SD)were measured pre-and postoperatively using Anterior Segment Visante-OCT.SD was defined as a line measured between the edge of the optic or its simulated image to the endothelium.Eyes were divided into 3 groups:convex,concave,and plane according to preoperatory iris configuration.Statistical analysis was performed using the R program,for the comparison of independent groups and multiple comparisons,the Kruskal-Wallis test and the Dunn test were used respectively.RESULTS:Mean difference between nasal preoperative SSD and postoperative RSD was-0.36±0.38,-0.29±0.48,and-0.18±0.30 mm in the concave,convex,and plane group,respectively.Mean difference between temporal SSD and RSD was-0.36±0.37,-0.14±0.38,and-0.24±0.33 mm in the concave,convex,and plane group,respectively.There were statistically significant differences between SSD and RSS for both nasal and temporal sides in the concave and plane group(P<0.002).CONCLUSION:Preoperative SSD and postoperative RSD for iris-claw p IOL shows significant differences in patients with concave and plane iris.