EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1054373
19 EW NEWS & OPINION December 2018 that the square-edge high index of refraction acrylic IOL is the culprit," Dr. Masket said. "ND appears to be related to how the IOL is positioned in the eye; if you take the same in the bag lens that induces negative dysphotopsia and pop that optic in front of the capsule, in all likelihood the negative dysphotopsia is going to go away." When it comes to primary re- verse optic capture (for second eyes of patients with ND in the previous- ly operated eye), while successful at dispelling ND, there can be issues.. "Without the optic in the capsule bag after surgery, the bag tends to shrink and get rapid onset fibrot- ic PCO," Dr. Masket said. In their series, all cases of primary reverse optic capture required laser posteri- or capsulotomy by 3 months after surgery. There can also be long-term concerns about positional stabili- ty of sulcus-placed lenses and iris chafing. This led Dr. Masket to design a lens that would mimic reverse optic capture, but one in which the bulk of the lens would remain in the capsule bag; however, a lip or cap would overlie the anterior capsule, preventing patients from getting negative dysphotopsia. This lens, the 90 S (Morcher, Stuttgart, Germa- ny), includes a groove that accepts the anterior capsule, he continued, adding that it has been in clinical trials in Europe. In essence the IOL is fixated by the anterior capsulotomy. Approximately 150 of these IOLs have been implanted and none have experienced ND. Dr. Masket hopes that practi- tioners take home the message that ND is a condition that should be on their radar as one that occurs when surgery has actually been perfect. Pa- tients need to understand that they will likely improve over time, but if ND persists, they can be helped surgically. ND should not be ignored as it may occur in 100,000 new cases annually in the U.S. alone. Hopeful- ly, practitioners can explain ND to patients and support them. "I would hope that the man- ufacturing sector will do better on this," Dr. Masket said. "We can't have 100,000 patients annually with chronic ND who had 'perfect surgery' but can be very unhappy," he said. EW Editors' note: Dr. Masket has financial interests with Morcher. Contact information Masket: avcmasket@aol.com References 1. Masket S, et al. Surgical management of negative dysphotopsia. J Cataract Refract Surg. 2018;44:6–16. 2. Vamosi P, et al. Intraocular lens exchange in patients with negative dysphotopsia symptoms. J Cataract Refract Surg. 2010;36: 418–24. WE ARE OPHTHALMOLOGY'S MOST TRUSTED BRAND diamatrix.com 800.867.8081 Diamond Knives Repairs and Reconfigurations X1 Iris Speculum Stainless Steel Knives Ophthalmic Instruments Suture + More DIAMATRIX