IOL exchange for positive and negative dysphotopsia

Abstract

Positive and negative dysphotopsia are complaints that sometimes occur after otherwise uneventful cataract surgery with intraocular lens (IOL) implantation. In positive dysphotopsia (PD), artefacts such as glare and halos are experienced around light sources, especially in scotopic conditions. In negative dysphotopsia (ND), a dark shadow or crescent is experienced in the temporal visual field, especially in photopic conditions. An IOL‐exchange, especially with an larger sized IOL, is one of the therapies of both conditions.In this presentation, first the surgical technique to perform an IOL‐exchange will be presented. In short, the initially implanted IOL is removed through a small corneal incision (3.0 mm) after luxation of the IOL in the anterior chamber and cutting it in half before extraction. Subsequently, the new IOL is injected directly into the bag through the 3.0 mm corneal incision that was used for the removal of the initial IOL.Subsequently the clinical results of such an IOL‐exchange, with the Aspira‐aXA, a monofocal, 1‐piece hydrophilic acrylic IOL with an optic diameter of 7.0 mm, will be presented. In total, 20 eyes of 16 patients with pseudophakic dysphotopsia were included in the analysis. Nine eyes suffered from PD, ten eyes from ND, and one eye from both complaints. 15 out of 20 eyes (75%) showed complete resolution of complaints after the IOL exchange and four eyes (20%) showed a partial resolution. Postoperatively, in one eye vitreous loss occurred and resulted in cystoid macular edema, and another eye developed posterior capsular opacification, all treated successfully.As the bag‐to‐bag IOL exchange with a 7 mm IOL resulted in partial or complete resolution of positive and negative dysphotopsia in the majority of patients (95%), it is a potential treatment for patients with dysphotopsia.