Case Report: The Visual Outcomes After Bilateral Implantation Of Acrysoft™Iq Vivity™ In A Patient With A High Kappa Angle

Advances in cataract surgery and intraocular lenses, have made it possible to reduce dependence on glasses and provide visual quality at different distances. However, aspects such as a high kappa angle may condition the choice of the type of intraocular lens, contributing to the lens decentration as it could cause discomfort and even a decrease in visual quality, especially with a multifocal lens.

The aim is to report the visual outcomes after bilateral implantation of Acrysoft™IQ Vivity™ in a patient with a high kappa angle.

This patient underwent surgery in OMIQ Institute of Ophthalmology, Barcelona (Spain) in January 2022. The surgery was performed one week apart between the two eyes, starting with the left eye.

A 60-year-old male patient presented at our department with complains of reduced visual acuity and asking for refractive surgery, having a BCVA of 0,155 in his right eye and 0,097 in left eye (LogMar VA). There was no history of any ocular pathology or previous ocular surgery but a mild amblyopia in his RE. Slit-lamp examination revealed the presence of cataract in both eyes.  Although the kappa angle is defined as the angle formed between the visual axis and the pupillary axis, an estimate was made using the distance between the vertex of the cornea and the pupillary center which showed a Chord µ value of 0.57mm@177º and 0.37mm@19º (Pentacam AXL Wave). These values advised against the implantation of a diffractive multifocal lens.

The visual examination was completed with a study of the macula and the Retinal Nerve Fiber Layer (RNFL) using OCT Spectralis and optical biometry (Lenstar 900).

The surgical options were explained to the patient and finally cataract surgery with the implantation of an Extended Depth of Focus lens model was agreed (Acrysoft™IQ Vivity™ Toric +26.00 DFT415 RE / Acrysoft™IQ Vivity™ Toric +23.50 DFT315 LE). The surgery was uneventful.

After one month, the patient presented an UCDVA of 0,022 in his RE and -0,02 in his LE, UCIVA of 0,097 in his RE and 0,0 in his LE and UCNVA of 0,125 in his RE and 0,0 in his LE (logMar VA). No presence of bothering visual disturbances in the McAlinden test nor in LDA (Light Distortion analyzer)

The Acrysoft™IQ Vivity™ lens has been a satisfactory option in this patient with a high preoperative kappa angle, allowing good visual acuity at distance and intermediate distance. Possibly, the design of the lens could allow for greater tolerance in these cases.