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Clemence Bonnet, Antoine P Brezin, Dominique Monnet; Dissatisfaction after implantation of multifocal intraocular lenses. Invest. Ophthalmol. Vis. Sci. 2017;58(8):335.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the causes of dissatisfaction after implantation of multifocal intra-ocular lenses (M-IOL).
Charts of consecutive patients referred for visual dissatisfaction after implantation of a multifocal were reviewed since January 2016. The following data were systematically recorded: types of complaint, uncorrected and corrected distance and near visual acuities, photic phenomena, refractive state, pupil diameter and wavefront aberrometry measurements, corneal topography and treatment. Two senior physicians (DM, AB) have to determine the main cause of dissatisfaction.
Twenty two eyes of 15 patients were analyzed. Mean age at the first consult was 68 years (sd 10.29 years). Eleven patients (73.3%) were female. Eleven IOL were available and all were diffractive. The most common cause for complaint was blurry vision. Ten patients (11 eyes, 50%) reported blurry vision for both distance and near, 2 patients (4 eyes, 18%) reported photic phenomena, 4 patients (5 eyes, 23%) reported both blurry vision and photic phenomena and two patients (4 eyes, 18%) reported dry-eye syndrome. Causes of blurry vision included ametropia (7 eyes, 31%), posterior capsule opacification (PCO) (7 eyes, 31%), IOL decentration (4 eyes, 18%) and dry-eye syndrome (3 eyes, 14%). Causes of photic phenomena included PCO (5 eyes, 23%), pre-operative irregular astigmatism (2 eyes, 9%), dry-eye syndrome (1 eye, 2%). Spherical aberrations were also high in this group for 6 patients (23%). A large pupil was found in 8 patients (36%) with blurry vision and 5 patients with photic phenomena (23%). Indication of M-IOL was inappropriate in 7 eyes (31%) (high myopia, pre-operative irregular astigmatism on corneal topography, posterior uveitis and chonic open angle glaucoma). The most common interventions proposed were treatment of refractive error (glasses or contact lenses, 11 eyes, 50%), treatment for dry eye (5 eyes, 23%) and laser capsulotomy (5 eyes, 23%). Controlateral cataract surgery was suggested in 3 patients (20%). Complementary refractive surgery was made in 3 eyes (14%). No intraocular lens exchange was performed.
Residual ametropia and astigmatism, IOL decentration, PCO and large pupil were the most significant etiologies. The cause can be identified and effective treatment measures taken in most cases. Furthermore, indications and contra-indications of M-IOL should be better known by ophthalmologists.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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