Presbyopia-Correcting Intraocular Lens With Butterfly-Shaped Central Area Successfully Implanted In A Large Angle Kappa Patient: A Case Report

Lens alignment on visual axis is crucial in intraocular lens (IOL) implantation, and even more so in the case of presbyopia-correcting IOLs. Literature shows that high values for angle kappa (≥0.6 mm) are associated with more photic phenomena and, therefore, a less satisfactory visual result after multifocal intraocular lens (mIOL) implantation. This case reports a large-angle kappa patient successfully implanted with a multifocal presbyopia-correcting IOL designed with a far-distance butterfly-shaped central area that allows the orientation of the lens so that the visual axis passes through the wider diameter of the central optic zone. Such design reduces dependence on angle kappa and minimizes the risk for unwanted side effects.

Single center case report.

A 51-year-old patient was referred for cataract surgery.  Preoperative binocular corrected distance visual acuity (CDVA) was 0.0 logMAR. The refraction wasf +6.0D, cylinder of -1.5D and axis of 20o for the rigth eye and +7.75D, cylinder of -3.5D and axis of 160o for the left eye. The  preoperative angle kappa value was 0.6 mm for the right eye and 0.8 mm for the left eye. 

The selected IOL design was the Precizon Presbyopic NVA Toric lens (Ophtec BV, Netherlands).

After implantation, follow-up visits were at 1 month and 10 months. At the last visit postoperative refraction was -0.25D of cylinder at 80o for the right eye and +0.25D sphere -0.50D cylinder at 170o for the left eye. Monocular and binocular corrected distance visual acuity (CDVA) was -0.2 logMAR. Uncorrected distance VA (UDVA) was -0.1, 0.0 and -0.1 logMAR for the right eye, left eye and binocularly, respectively. Uncorrected intermediate VA (UIVA) at 66 cm was 0.2, 0.3 and 0.1 logMAR for the right, left eye and binocularly respectively, whereas uncorrected near VA (UNVA) was 0.3 for both eyes and 0.1 logMAR binocularly. Corrected binocular defocus curve at the last visit shows excellent vision at the 0.00D defocus level and a smooth transition from far to intermediate and near distances. No dysphotopic phenomena, such as glare, haloes, reduced contrast sensitivity or reduced quality of vision at night were experienced by the patient. The patient reported complete satisfaction with the implanted IOLs.

This case report shows that Precizon Presbyopic NVA (Ophtec BV, The Netherlands) IOL also has an excellent visual performance and patient satisfaction in eyes with larger angle kappa values, probably thanks to its butterfly-shaped central area that allows the orientation of the lens so that the visual axis passes through the wider diameter of the optic zone.