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F. A. Bucci, Jr.; "Vaseline Vision Dysphotopsia" and Explantation of the ReSTOR Multifocal Implant. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3119. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To report the incidence of explantation with the ReSTOR (RS) and ReZoom (RZ) multifocal IOLs and characterize the syndrome of "Vaseline vision dysphotopsia" (VVD).
530 eyes (56% ref. lensectomy/44% cataract) were implanted (RS-300, RZ-230) during an 18 month period (6/1/05-12/1/06). A retrospective study examining the incidence, profile, and rate of explantation of pts experiencing VVD was completed. The symptom terminology most commonly used by pts with VVD includes "vaseline vision", "waxy vision", "shadowy vision", "3- D vision", "filmy vision", "hazy vision", "hologram vision", and "dirty lens vision".
The incidence of severe VVD for the RS eyes was 3.66% (11/300) and for the RZ lens was 0.0% (0/230). The incidence of explantation for the RS was 2.33% (7/300) and for the RZ it was 0.0% (0/230). The mean time between implantation and explantation was 9.14 mos (range 6-13 mos). Six RS IOLs successfully underwent "in the bag" exchange with 5 RZ and one monofocal IOL. The seventh exchange was a RZ "in the bag sulcus" exchange with victrectomy s/p YAG capsulotomy. Despite temporarily increasing their residual refractive error, all pts reported complete relief of their severe "VVD" symptoms. Pre-explant, 6/7 pts had AK and all pts achieved excellent Snellen acuity with minimal residual refractive error. Factors not correlating with VVD explantation include pre op refractive error (4 myopia/3 hyperopia), procedure type (4 RL, 3 cataract), pupil size (4/7 ≤ 5 mm, 3/7 ≥ 6 mm) and opposite eye status (4 pseudophakic, 3 phakic). Seventeen of 55 bilateral RS/RS pts complained of severe intermediate vision problems. None of the pts undergoing explantation were in the intermediate complaint group.
1.) Severe VVD is a debilitating visual syndrome which occurred in 3.66% of RS eyes and 0% of RZ eyes. 2.) Despite excellent acuities at distance and near and 9 months of neuroadaptation, explantation was required to relieve symptoms in most cases of VVD. 3.) All cases undergoing explantation achieved rapid relief of symptoms despite temporary increases in residual refractive errors. 4.) Explantation was easily achieved after many months. 5.) "In the bag" IOL exchange was achieved in all (6/7) non-YAG eyes. 6.) No explanations were required in 230 RZ eyes. 7.) 31% of RS/RS pts had spontaneous intermediate visual complaints, but none of these pts had severe VVD requiring explantation.
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