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Visual aberrations in a multifocal intraocular lens with injection-related scratches: case report and laboratorial analysis

Poster Details

First Author: S.Cole USA

Co Author(s):    L. Werner   A. Crandall           

Abstract Details



Purpose:

We describe the case of a 70-year-old female patient who underwent phacoemulsification and implantation of a single-piece hydrophobic acrylic multifocal intraocular lens (IOL). Following surgery she experienced blurring, positive dysphotopsias, impaired night vision and glare. After two years, she sought a second opinion. When optic damage likely related to the IOL injection procedure was noted, IOL explantation was performed.

Setting:

John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA

Methods:

The IOL was viscodissected from the capsular bag, and brought into the anterior chamber. The lens was then folded, and removed whole. Another IOL of the same design was implanted in the capsular bag, and the incision was closed with stromal irrigation. The explanted IOL was sent to the Intermountain Ocular Research Center. Gross examination was performed and gross pictures were taken. The specimen was then evaluated and photographed under a light microscope. Scheimpflug photography with densitometry analysis was then performed to measure the amount of light scattering on the anterior surface of the lens ( EAS-1000 Scheimpflug camera; Nidek, Inc.). Results were expressed in computer-compatible tape (CCT) units. This is a measure of brightness or intensity of reflected (scattered) light on a scale from 0 (black) to 255 (white).

Results:

Macroscopically, the single-piece, hydrophobic acrylic, multifocal, blue light-blocking lens with haptics was overall intact. The anterior surface of the optic was however notable for a large central defect and a few peripheral scratches. Light microscopy revealed 3 large, linear, parallel scratches (approximately 2.0 mm long) occupying the central part of the optic, as well as other thinner, linear scratches and defects in the paracentral and peripheral area of the optic and corresponding haptic. The scratches and defects appeared mostly on the anterior surface of the lens (optic and 1 haptic). The anterior surface showed an apodized diffractive pattern consistent with a multifocal PCIOL. Scheimpflug photography with densitometry analysis found light scattering to be extremely high (measured as 227 CCTs) at the anterior surface of the explanted lens, within the area corresponding to the aforementioned scratches. This is in contrast to 28 and 18 CCTs on the anterior and posterior surfaces, respectively in areas without scratches.

Conclusions:

The case described here warrants consideration of immediate explantation/exchange of a lens damaged after injection, based on the extent and location of the damage, as well as characteristics of the optic. FINANCIAL INTEREST: NONE

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