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M. A. Woodward, J. B. Randleman, R. D. Stulting; Reasons for Patient Dissatisfaction After Multifocal Intraocular Lens Implantation. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5282.
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To analyze outcomes and reasons for dissatisfaction in eyes after phacoemulsification with multifocal intraocular lens implantation.
Retrospective review of 52 eyes from 38 patients dissatisfied with visual outcomes after multifocal lens implantation. Outcomes analyzed included type of visual complaint, nature of treatment modality for each complaint, and presence or absence of clinical improvement.
Patients complaints could be characterized as blurred vision resulting from ametropia, post-operative complications [cystoid macular edema, dry eye, lens decentration, posterior capsular opacification (PCO)], photic phenomena [glare, halos, dysphotopsias], or a combination of both. Blurred vision occurred in 47 (91%) eyes resulting from ametropia in 21 (45%)eyes, post-operative complications such as dry eye and cystoid macular edema in 8 eyes, lens decentration in 6 (13%) eyes, and early PCO in 23 (49%) eyes. Photic phenomenon occurred in 16 (30%) eyes resulting from intrinsic lens properties in 5 (31%) eyes, lens decentration in 5 (31%) eyes, retained lens fragment in 1 (6%) eye, and PCO in 8 (50%) eyes. In 15 (27%) eyes, the etiology of blurred vision and photic phenomenon was multifactorial. Blurry vision was manifest as decreased near vision in 20 (38%) eyes, decreased distance vision in 11 (21%) eyes, and both in 16 (31%) eyes. Dissatisfied patients were identified by clinical findings and treated accordingly. 23 (44%) of these patients experienced clinical improvement with various treatment modalities including refractive surgery for 3 (13%) eyes, complication management for dry eye and for inflammation for 2 (9%) eyes, brimonidine administration for photic phenomena in 2 (9%) eyes, YAG capsulotomy for 15 (65%) eyes, and lens repositioning or lens exchange in 2 (9%) eyes. An additional 17 (33%) eyes were pending treatment results. 17 (74%) eyes required only 1 modality of treatment, while 6 (26%) eyes required more than 1 treatment modality.
Patient dissatisfaction presents as blurry vision, photic phenomenon, and frequently as a combination of both. Most patients can be successfully managed and experience clinical improvement with one or more treatment modalities.
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