Modification Of Surgical Procedure To Achieve Independence From Glasses In A Patient With An Incorrectly Implanted Add-On Lens

Published 2024 - 42nd Congress of the ESCRS

Reference: PO025 | Type: Case Report | DOI: 10.82333/1yhb-ka47

Authors: Ewa Mrukwa-Kominek* ¹ , Katarzyna Jadczyk-Sorek ¹ , Porwolik Mateusz ² , Wojciech Maruszczyk ³ , Wojciech Lubon ¹

¹Dept of Ophthalmology,Silesian University of Medicine Faculty of Medical Sciences in Katowice,Katowice,Poland;Dept of Ophthalmology,Prof. K. Gibinski University Clinical Center of theSilesian University of Medicine,Katowice,Poland, ²Dept of Ophthalmology,Prof. K. Gibinski University Clinical Center of theSilesian University of Medicine,Katowice,Poland;Dept of Ophthalmology,Silesian University of Medicine in Katowice,Katowice,Poland, ³Dept of Ophthalmology,Prof. K. Gibinski University Clinical Center of theSilesian University of Medicine,Katowice,Poland

Purpose

.The aim of the study is to present the case of a patient with astigmatism who wished to become independent from glasses and in whom an add-on lens was implanted incorrectly; the work presents a modification of the surgical procedure to achieve therapeutic success.

Setting

1Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia,

2Department of Ophthalmology, Prof. K. Gibinski University Clinical Centre, Medical University of Silesia in Katowice, Poland

Report of case

A 42-year-old patient with astigmatism, who wished to be independent from glasses, was not eligible for premium lens implantation due to her anterior segment of the eye condition and angle alpha >0.5. Preoperative refraction in both eyes was -1.5Dsph +2.0D cyl.

Cataract phacoemulsification was performed first in RE (BCVA= 0.7) and after 2 weeks in LE (BCVA=0.9). Toric monofocal IOL with value of +19.5D ax 101 and ax 79 degree was implanted in RE and LE respectively. After the surgery, UCDVA = 1.0 (100%) was achieved in both eyes. However, BCNVA with correction +3.5D was 0.5 (Snellen charts) and was not satisfactory for the patient. After 2 months, a decision to perform an additional procedure was made – implantation of Sulcoflex trifocal IOL (Rayner, UK).

Next day after the Sulcoflex implantation, UDVA in RE was 1.0, in LE was 0.8; BCDVA of LE (with correction -0.5 D sph) was 1.0. UCNVA in both eyes 0.5. RE was perfect: UCVA 1.0 UNVA 0.5 and IOP 14 mmHg without medication. However in LE the IOP was 29mmHg and the anterior chamber was shallow which caused strong pain of the eye. LPI was done without improvement. After 2 weeks AS-OCT showed the wrong implantation of the lens. The decision of removing the Sulcoflex IOL was made, but finally the surgery modification allowed to avoid the explantation of the add-on lens.

After 6 M patient satisfaction was high and only minor subjective glare impression. IOP has been stabilized, the anterior chamber and cornea remained stable.

Conclusion/Take home message

To correct refractive error in a patient who wants independence from spectacles, two-stage lens implantation is a good solution.

In case of high IOP after surgery the AS-OCT should be made to clarify the position of the lens.

The reposition of Sulcoflex Add-on IOL can proceed without explanting the previous lens.