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Treatment of negative and positive dysphotopsia with piggyback implantation of Rayner Sulcoflex lens

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Session Details

Session Title: Cataract Surgery Complications

Session Date/Time: Monday 15/09/2014 | 08:00-10:30

Paper Time: 09:14

Venue: Boulevard A

First Author: : N.Makhotkina THE NETHERLANDS

Co Author(s): :    T. Berendschot   R. Nuijts           

Abstract Details


Negative and positive dysphotopsia are well-known side effects after cataract surgery. Implantation of a secondary IOL in the ciliary sulcus anterior to the IOL-capsular bag complex has been suggested as an effective option to treat dysphotopsia by changing the intraocular light pathway. The aim of the current research is to determine the effectiveness of this reversible and save surgical treatment of dysphotopsia.


University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands.


Prospective interventional case series of patients with severe negative and positive dysphotopsia that were treated with piggyback implantation of Rayner Sulcoflex 653L IOL (Rayner Intraocular Lenses Ltd.) with powers from -0.5 to 0.5D. All patients underwent phacoemulsification with IOL implantation in the capsular bag. Pre- and postoperative evaluation of patients included standard ophthalmological examination, Scheimpflug photography (Pentacam), anterior segment optical coherence tomography (Visante, Carl Zeiss Meditec, Inc, Dublin, CA or Casia, SS-1000, Tomey Corporation) and VHF-ultrasonography (UBM, Quantel). Main outcome measurements were subjectively reported complaints of dysphotopsia at 3 months follow-up, mean iris-piggyback IOL distance at 0◦ and 180◦, mean anterior chamber volume (ACV) and mean anterior chamber depth (ACD).


A Rayner Sulcoflex IOL was implanted in 3 patients (3 eyes ) with negative dysphotopsia, in 3 patients (4 eyes) with positive dysphotopsia and in 1 patient (1 eye) with combined symptoms. Mean age of the patients (±SD) was 59,5 ±8,1 years. At 3 months follow-up the negative dysphotopsia resolved completely in two eyes, partially in one eye and was unchanged in one eye. Two patients were satisfied with the result, one was neutral and one was dissatisfied. Positive dysphotopsia resolved partially in three eyes, was unchanged in one eye and increased in one eye. Two patients (3 eyes) were satisfied despite only a partial resolution of the symptoms, and two patients (2 eyes) were dissatisfied with the result. Piggyback implantation of Rayner Sulcoflex reduced iris-IOL distance at 0 and 180◦ by 93% and 97% respectively, ACD by 20% and ACV by 11%. Explantation of Sulcoflex IOL was performed in one patient (1 eye) with combined symptoms, who reported an increased positive and an unchanged negative dysphotopsia after the secondary surgery. After explantation, the combined dysphotopsia returned to preoperative levels. No other complications have been recorded during 3 months of follow-up.


Secondary implantation of Rayner Sulcoflex IOL can successfully treat negative dysphotopsia and is also moderately successful in patients with positive dysphotopsia. The decrease in distances between the Rayner Sulcoflex IOLs and the posterior iris might be an explanation for the resolution of symptoms, although more research is needed to explain this relationship.

Financial Interest:

One or more of the authors... receives consulting fees, retainer, or contract payments from a competing company, One or more of the authors... research is funded, fully or partially, by a competing company, One or more of the authors... receives nonNONEmonetary benefits from a company producing, developing or supplying the product or procedure presented.

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