Abstract
In modern cataract surgery, the precision by which the target refraction is achieved still remains unsatisfactory in many cases. Potential reasons include interindividual differences in wound healing, a postoperative shift of the anatomical position of the lens or previous refractive laser surgery. A system that allows for postoperative adjustment of target refraction would be highly beneficial. The light-adjustable lens (LAL, Calhoun Vision, Inc., Pasadena, CA) potentially represents such a system where refractive power is adjusted postoperatively using photosensitive silicone molecules and irradiation with ultraviolet (UV) light.1Sandstedt C.A. Chang S.H. Grubbs R.H. Schwartz D.M. Light-adjustable lens: customizing correction for multifocality and higher-order aberrations.Trans Am Ophthalmol Soc. 2006; 104: 29-39PubMed Google Scholar, 2Schwartz D.M. Light-adjustable lens.Trans Am Ophthalmol Soc. 2003; 101: 417-436PubMed Google Scholar, 3Schwartz D.M. Sandstedt C.A. Chang S.H. et al.Light-adjustable lens: development of in vitro nomograms.Trans Am Ophthalmol Soc. 2004; 102 (discussion 72–4): 67-72PubMed Google Scholar Based on the principle of photochemistry and diffusion and using a well-defined spatial and temporal UV irradiance profile, the LAL is modified to add or subtract spherical power. Ultraviolet radiation is applied at clearly defined postoperative times. Between these time points and during the first 2 postoperative weeks, it is mandatory for the patient to protect the eye from any unscheduled UV exposure by using UV protection glasses.4Chayet A. Sandstedt C. Chang S. et al.Correction of myopia after cataract surgery with a light-adjustable lens.Ophthalmology. 2009; 116: 1432-1435Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 5Chayet A. Sandstedt C.A. Chang S.H. et al.Correction of residual hyperopia after cataract surgery using the light adjustable intraocular lens technology.Am J Ophthalmol. 2009; 147: 392-397.e1Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar The proof of principle of the method was given recently in 2 pilot studies for the correction of myopia and hyperopia.4Chayet A. Sandstedt C. Chang S. et al.Correction of myopia after cataract surgery with a light-adjustable lens.Ophthalmology. 2009; 116: 1432-1435Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 5Chayet A. Sandstedt C.A. Chang S.H. et al.Correction of residual hyperopia after cataract surgery using the light adjustable intraocular lens technology.Am J Ophthalmol. 2009; 147: 392-397.e1Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar We here report on the implantation of a +10.0 diopter (D) LAL in the left eye of a 57-year-old female patient with bilateral cataract that we performed in April 2009. Preoperatively, manifest refraction was −9.75 −1.25 × 175 and best spectacle-corrected visual acuity (BSCVA) was 20/25. Bilateral slit lamp examination and examination of the central and peripheral retina showed no pathological findings except for the cataract. Surgery was uneventful and the postoperative examinations at 1 day and 1 week after surgery showed regular findings. At day 14 after surgery, the point in time when the first UV irradiation is performed following the manufacturer's protocol, the patient reported decreased vision and halos in the operated eye. Refraction was −1.25 −0.5 × 115 and BSCVA was 20/40. We performed the UV irradiation as planned. One week later, refraction was sphere (sph) −3.25 and BSCVA had decreased to 20/125. We noted a distinct paracentral elevation in the lens in slit lamp examination (Fig 1 A-B, available at http://aaojournal.org). Upon questioning, the patient admitted that she had not used the UV protecting glasses at several occasions during the postoperative period and had exposed herself to sunlight for several hours. We explanted the LAL and implanted a conventional intraocular lens (+10.0 D Acrysof Natural, Alcon Laboratories Inc, Fort Worth, TX) (Fig 1 C-D, available at http://aaojournal.org). At 1 week after the lens exchange, refraction was sph −0.5 and BSCVA was 20/25. This report demonstrates that postoperative compliance might be of extraordinary importance in patients receiving LALs and that the sensitivity by which the lens reacts to unplanned UV exposure might be extraordinarily high. Correction of Myopia after Cataract Surgery with a Light-Adjustable LensOphthalmologyVol. 116Issue 8PreviewTo determine whether residual myopia could be corrected postoperatively using the light-adjustable lens (LAL) technology in patients undergoing cataract surgery and LAL implantation. Full-Text PDF
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