EyeWorld Asia-Pacific March 2019 Issue

42 March 2019 EWAP CATARACT / IOL effective such treatments were for alleviating negative dysphotopsia. For the 22 patients who underwent reverse optic capture as a secondary procedure, investigators determined that this was almost always successful. “We’ve had success in all but one case,” Dr. Masket said, adding that in 21 primary cases they’ve been 100% successful. The investigators, including Dr. Masket’s partner, Nicole Fram, MD, also evaluated which IOLs were involved in cases of negative dysphotopsia and found that virtually all IOLs could be associated with this. They determined that in their series, 23% of IOLs were silicone and 12.8% of these had round edges. “I hope that we have been successful in dispelling the myth that the square-edge high index of refraction acrylic IOL is the culprit,” Dr. Masket said. “ND appears to be related to how the IOL is positioned in the eye; if you take the same in the bag lens that induces negative dysphotopsia and pop that optic in front of the capsule, in all likelihood the negative dysphotopsia is going to go away.” When it comes to primary reverse optic capture (for second eyes of patients with ND in the previously operated eye), while successful at dispelling ND, there can be issues.. “Without the optic in the capsule bag after surgery, the bag tends to shrink and get rapid onset fibrotic PCO,” Dr. Masket said. In their series, all cases of primary reverse optic capture required laser posterior capsulotomy by 3 months after surgery. There can also be long- term concerns about positional stability of sulcus-placed lenses and iris chafing. This led Dr. Masket to design a lens that would mimic reverse optic capture, but one in which the bulk of the lens would remain in the capsule bag; however, a lip or cap would overlie the anterior capsule, preventing patients from getting negative dysphotopsia. This lens, the 90 S (Morcher, Stuttgart, Germany), includes a groove that accepts the anterior capsule, he continued, adding that it has been in clinical trials in Europe. In essence the IOL is fixated by the anterior capsulotomy. Approximately 150 of these IOLs have been implanted and none have experienced ND. Dr. Masket hopes that practitioners take home the message that ND is a condition that should be on their radar as one that occurs when surgery has actually been perfect. Patients need to understand that they will likely improve over time, but if ND persists, they can be helped surgically. ND should not be ignored as it may occur in 100,000 new cases annually in the U.S. alone. Hopefully, practitioners can explain ND to patients and support them. “I would hope that the manufacturing sector will do better on this,” Dr. Masket said. “We can’t have 100,000 patients annually with chronic ND who had ‘perfect surgery’ but can be very unhappy,” he said. EWAP References 1. Masket S, et al. Surgical management of negative dysphotopsia. J Cataract Refract Surg. 2018;44:6–16. 2. Vamosi P, et al. Intraocular lens exchange in patients with negative dysphotopsia symptoms. J Cataract Refract Surg. 2010;36: 418–24. Editors’ note: Dr. Masket has financial interests with Morcher. Contact information Masket: avcmasket@aol.com Surgical remedy - from page 41