Eyeworld

18 | EYEWORLD | DECEMBER 2020 ASCRS NEWS Contact Pershing: pershing@stanford.edu ocular comorbidities, time since initial cata- ract surgery, extent of capsular fibrosis, and skill of the surgeon, and it is essential to have an informed discussion of risks and expected benefits weighed against severity of a patient's symptoms. Despite limitations, this study offers an important early step in understanding positive dysphotopsias, including contribution of IOL refractive index and square-edge IOL design and the potential role of IOL exchange. Its promising results prompt future studies of IOL exchange for PD, with larger sample size and a broader pool of surgeons to compare outcomes with specific replacement IOLs, IOL material, and surgical approaches, and to investigate incidence of complications. IOL exchange rep- resents an important tool in the arsenal of oph- thalmologists to address this challenging visual phenomenon that affects patients worldwide. useful information for preoperative discussions and decision-making. Limitations of this study include its ret- rospective non-randomized design and con- strained sample size for statistical comparisons among IOL types. Included patients volunteered their PD symptoms; there was no questionnaire to screen for PD, which is usually underreport- ed, 8 potentially introducing sampling bias. Find- ings may also be influenced by placebo effect, given the subjective nature of PD and lack of a control population. Finally, only two physicians performed IOL exchanges in this study, which places substantial weight on their specific surgi- cal skills and may limit generalizability. It is also important to consider that al- though reported success rates in this study are high, there are inherent risks to IOL exchange including capsular compromise, zonular dehis- cence, endophthalmitis, and cystoid macular edema. 11,12,13,14 Risk may be influenced by other continued from page 17 References (cont.) 9. Masket S, et al. Surgical man- agement of negative dyspho- topsia. J Cataract Refract Surg. 2018;44:6–16. 10. Erie JC, et al. Analysis of post- operative glare and intraocular lens design. J Cataract Refract Surg. 2001;27:614–621. 11. Davies EC, Pineda R. Intraoc- ular lens exchange surgery at a tertiary referral center: Indica- tions, complications, and visual outcomes. J Cataract Refract Surg. 2016;42:1262–1267. 12. Jones JJ, et al. Indications and outcomes of intraocular lens exchange during a recent 5-year period. Am J Ophthalmol. 2014;157:154–162.e1. 13. Marques FF, et al. Longitu- dinal study of intraocular lens exchange. J Cataract Refract Surg. 2007;33:254–257. 14. Dagres E, et al. Perioperative complications of intraocular lens exchange in patients with opacified Aqua-Sense lenses. J Cataract Refract Surg. 2004;30:2569–2573. Surgical management of positive dysphotopsia: U.S. perspective Samuel Masket, MD, Zsofia Rupnick, MD, Nicole Fram, MD, Stephen Kwong, BS, Jessie McLachlan, BA J Cataract Refract Surg. 2020;46(11):1474–1479. n Purpose: To evaluate clinical outcomes of IOL exchange for intolerable positive dysphotopsia (PD) n Setting: Private practice, Advanced Vision Care, Los Angeles, California n Design: Retrospective review, case series n Methods: 56 eyes of 46 pseudophakic patients requiring surgical management of PD between 2013 and 2019 were reviewed. Thirty-seven eyes had PD alone and 19 had combined negative dysphotopsia (ND) and PD. Inclusion criteria: BCVA of 20/30 or better without significant corneal, retinal, or optic nerve pathology. Exclusion criteria: Corneal, macular, or optic nerve disease, multifocal dysphotopsia alone (defined patterns of concentric multiple halos or spider web patterns when looking at a point source of light). Primary outcome measure was improvement or resolution of self-reported PD symptoms by 3 months after surgery. Secondary outcome measures included analysis of IOLs that induced PD with regard to IOL material, index of refraction and edge design. n Results: IOL materials successful in the alleviation of PD symptoms were as follows: 20/33 silicone (87.8%), 15/21 copolymer (76.2%), and 2/2 PMMA (100%). However, when considering IOL exchange for an acrylic to silicone optic or acrylic to collamer optic the percentages of improvement are indistinguishable at 87% and 88%, respectively. n Conclusion: PD symptoms may be improved by changing the IOL material and, therefore, index of refraction. Although edge design plays an important role in etiology, changing the IOL material to a lower index of refraction may prove to be an effective surgical strategy to improve intolerable PD.

• Blank Page
• Blank Page (1)