Five Year Follow-Up Of Reverse Optic Capture Trifocal Intraocular Lens Implantati̇on After Pars Plana Vitrectomy For Total Nucleus Drop

To invastigate the refractive and visual outcomes of reverse optic ıntraocular trifocal lens implantation after posterior capsule rupture and pars plana vitrectomy for total nucleus drop up to five years.

Complication management of a multifocal ıntraocular lens implantation at a private clinic

64 year old female patient visited Batigöz Surgical Medical Center for vision loss at June 2018. She had a posterior subcapsular and grade 2-3 nuclear cataract on the right eye. Left eye was also posterior subcapsular cataract and grade 2 nuclear cataract. BCVA  was 0.4 on the right eye and 0.6 logMAR on the left. Corneal topography (Sirius , CSO), retinal OCT ( Cirrus 4000, Carl Zeiss Meditec) , visual field test 24/2 (Humphrey Visual Field Analyser, Carl Zeiss Meditec) findings were all normal. Trifocal intraocular lens ( Liberty, Medicontur) implantation was planned, 17.50 D for right eye 19.50 D for the left eye. During right eye surgery, after manuel 5 mm fine CCC a very subtle hydrodissection was done. Right after the phaco tip insertion to anterior chamber was observed to be deepened. Total nucleus drop occured. Nucleus was floated to anterior chamber and phaco fragmanted via PPV. Since the CCC was kept safe, reverse optic capture was preferred to implant trifocal ıntraocular lens. Till second week visit VA was 0.6 logMAR far and Jaeger 5 near monocular. One month control VA was 0.8 far Jaeger 2 near. Because of the anxiety of the first surgery and other systemic surgery required diseases (obs&gyn) left eye trifocal implantion (19.50 D Liberty,Medicontur) could be done two years later at June 2020. At the last visit March 2023, binocular VA was 1.0 and Jaeger 1. Reverse optic captured IOL was perfectly centralized still and photographed from biomicroscope. 

When the promise to patient tried to be kept, after posterior capsule perforation and total nucleus drop,  reverse optic capture of multifocal ıntraocular lens can be considered as an option rather than skipping to monofocal options.