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M. Swanic, H. Wu; Negative Dysphotopsia Occurrence With Toric IOLs and Its Management. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5447.
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© ARVO (1962-2015); The Authors (2016-present)
Toric Intraocular lenses (IOLs) have become a popular form of correcting corneal astigmatism at the lenticular plane. In general these lenses are very well tolerated and have been well received by patients. In our review we attempt to describe a specific visual complaint of patients with Alcon Toric IOLs and how it was successfully relieved through surgical management.
Charts of patients with Alcon Toric IOLs were reviewed for complaints of temporal shadows associated with shimmering lights. These patients then had their postoperative course analyzed up to the point of symptom resolution.
2 patients previously implanted with Alcon Toric IOLs (SN6AT4 and SN60T5) were noted to have negative dysphotopsias (temporal crescents with associated shimmering.) Both patients experienced the symptoms on postoperative day 1 and were highly bothered by their presence. The patients were initially counseled to await neuroadaptation. Both patients had ultrasound biomicroscopy performed to evaluate the space between the IOL optic and the patient's iris. This appeared normal in both patients.One patient underwent piggyback IOL placement of a plano acrylic AMO Clariflex lens with minimal resolution of symptoms. Both patients underwent IOL exchange with placement of the silicone, round edged, STAAR AQ2010V with complete resolution of temporal shadows and disturbing shimmering lights. Mean Patient age was 53. Mean Preop BSCVA was 20/30. Mean Pupil size in ambient light was 4.3mm. Mean postop BSCVA was 20/25. Mean timing of IOL exchange was 5 months post toric IOL implantation.
Previously described "negative dysphotopsias" seen with other acrylic IOLs with square edges are also seen with the newest generation of Toric IOLs. These can be especially problematic in patients with high expectations from "premium" IOLs. IOL exchange with replacement of the Toric IOL for an IOL with a silicone design with a round edge is one successful strategy for resolution of symptoms. Placing a "piggyback" IOL was unsuccessful in removing the shadow in one patient.
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