YAG CAPSULOTOMY IS A SUCCESSFUL TREATMENT FOR THE MADDOX ROD EFFECT PRODUCED BY A POSTERIOR CAPSULAR CREASE IN PSEUDOPHAKIC EYES.

To describe the clinical features of the Maddox rod effect – a linear dysphotopsia created by a posterior capsular crease following cataract surgery and report the efficacy of YAG capsulotomy.

In 1980, Maddox contextualised the use of cylindrical refraction for detecting heterophorias/tropias by fashioning a device, “The Maddox Rod”, that produces a line focus orthogonal to the cylindrical axis. A posterior capsular crease has been identified as one of the causes of a post-operative positive dysphotopsia, and causes cause an orthogonal line focus consistent with a Maddox rod-like effect.

A case series with clinical images is presented that describes the diagnostic features of the Maddox rod effect produced by a posterior capsular crease. The clinical course and efficacy of YAG capsulotomy is reported. 

13 cases of a Maddox rod effect were identified from a single surgeon’s clinical records. In each case, clinical photographs confirmed a well-defined, linear crease visible on the posterior lens capsule. Each patient described seeing a linear streak emanating from any point source of light, which was confirmed when the patient drew their own subjective point spread function. The direction of the streak was always orthogonal to the direction of the capsular fold. The time from surgery to diagnosis was 10 weeks (SD = 7.4). YAG capsulotomy was performed in 46 % (n = 6) and successfully resolved the dysphotopsia in 83% (n = 5). 1 eye (8%) had spontaneous resolution of symptoms without intervention.

A linear fold of the posterior capsule can cause a characteristic linear dysphotopsia at an orientation that is orthogonal to the direction of the fold. This may spontaneously resolve, though can also be successfully treated with YAG capsulotomy.