Aberrations Induced By Severe Bending Of Plate Haptic Iols

To show a case of an unhappy patient caused by severe bending of plate haptic IOLs in both eyes after refractive lens exchange.

Private eye clinic in Germany

A patient was transferred to our clinic several months after refractive lens exchange for high myopia. He complained of deteriorating vision on both, but more so on the left eye. The first surgeon did see no need for secondary surgical intervention. Implanted IOL power was OD +6.0 and OS –1.0. Refraction was OD ±1.25 – 1.5 cyl and OS +5.50 – 4.00 cyl. UCVA was logMAR OD 0.2 and OS 0.6, DCVA OD 0.0 and OS 0.0. Slit lamp examination revealed a strong anterior capsular contraction in both eyes, a moderately concave front surface on the right and a severly concave one on the left eye. OCT scans showed an IOL bending of approx. 30° on the right eye and 70° on the left eye (90° = L shape, 180° = U shape). This induces severe aberrations, low order (sphere and cylinder) as well as high order ones.

While it is possible to correct the patient to 20/20 vision with spectacles, the situation is unsatisfactory as the patient demanded spectacle independence in the first place. Bending is initiated by a large contact area of capsule and IOL, inducing severe fibrosis and contraction. It is further enhanced by the low center thickness of the IOLs, enabling forces to be transferred from the haptics to the optic more easily. A surgical intervention to relieve the contraction of the capsule and the compression forces of the IOL seems sensible.