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A study of incidence and etiological factors of negative dysphotopsia after temporal clear corneal uniplanar incision phacoemusification with foldable IOL implantation
Session Title: IOL Technology
Session Date/Time: Sunday 06/10/2013 | 16:30-18:30
Paper Time: 16:30
Venue: Auditorium (First Floor)
First Author: : P.Sharma INDIA
Co Author(s): : S. Kalia
The purpose of this study was to evaluate the incidence of negative dysphotopsia (ND) after temporal clear corneal, 2.2 mm, uniplanar incision phacoemulsification surgery with implantation of foldable, acrylic posterior chamber intraocular lens (IOL). It was also attempted to find the correlation, if any, with the type of IOL (hydrophobic or hydrophilic), incisional and other possible factors and associations of ND.
This study was conducted at the Department of Ophthalmology, SMS Medical College & Hospital, Jaipur, INDIA. The design was a hospital based age and sex matched prospective comparative case series conducted for a period of 1 year on 320 eyes that underwent routine phacoemulsification with, in the bag implantation of foldable acrylic single piece IOL for senile, uncomplicated cataracts under topical anaesthesia.
After applying appropriate inclusion and exclusion criteria, eyes were randomly assigned to one of the four equal groups. Group A : Hydrophobic acrylic IOL (Acrysof® IQ) with wound hydration; Group B : Hydrophilic acrylic IOL (CT Asphina® 603P) with wound hydration; Group C : Hydrophobic without wound hydration and Group D : Hydrophilic without wound hydration. A temporal clear corneal 2.2 mm uniplanar wound construction was done. Eyes without wound hydration were patched for 24 hours. Patients were followed at day 1, day 7 and 6 weeks post operatively and those spontaneously reporting negative dysphotopsia were studied. These patients filled a questionnaire detailing the dysphotopsia. Duration of dysphotopsia was noted, Anterior segment Optical Coherence Tomography (ASOCT), Humphrey’s automated full field analysis was done apart from routine post operative examinations. Results were compiled and studied. ANOVA, t- Test & Chi Square tests were used for statistical analysis as & when required.
The overall incidence of negative dysphotopsia (ND) on first post-operative day was 9.06%. This rapidly decreased to 1.56% by the end of 6 weeks. First day ND incidence was significantly higher in the hydrated wound group (13.12% hydrated vs 5% non-hydrated, p<0.0039). There was no statistically significant difference of ND rates between the sexes (male 11.42%, female 6.20% ; p<0.105). The mean age of total population was 62.96 yrs. Mean age group of ND patient sub-group was 55.17 yrs (n=29, S.D. 9.9) as compared to mean age of 63.74 yrs (n=291, S.D. 10.55) of patients not experiencing ND (p<0.001). Right eyes experienced significantly lesser ND (5.49%) as compared to left eyes (13.77%) (p<0.0107). No statistical difference was found in ND overall rates between hydrophobic IOL (11.25%) and hydrophillic IOL (6.87%) (p=0.1729). ND persisting beyond 6 weeks was noted higher in the hydrophobic IOL group (2.5%) versus hydrophilic (0.625%). All eyes with persistent ND had iris-optic distance of more than 460 microns. No field defect was detected with Humphrey Automated full-field analysis in eyes with ND persisting at 6 weeks.
This is the first study evaluating the incidence of ND after 2.2mm temporal clear corneal uniplanar phacoemulsification surgery in Indian eyes. There was lesser overall incidence of ND as compared to previous studies. There was no correlation of gender in the incidence of ND. There was a significant higher incidence of transient ND after wound hydration which may be attributed to residual stromal hydration. There was a significant higher incidence in left eyes. Younger age group showed a significant higher occurrence of ND as they are generally more active, highly observant, analytical and slightly anxious by nature. Though the total incidence of ND was identical in hydrophobic and hydrophilic IOLs, persistent ND for 6 weeks or more was higher in the hydrophobic group. This could be attributed to thinner profile and truncated edge design of the Alcon®IQ. There was no patient with symptoms severe enough to necessitate surgical intervention.