Secondary positioning of rotationally asymmetric refractive multifocal intraocular lens in a patient with glaucoma: A case report

Abstract

Background: Asymmetric multifocal intraocular lenses (IOLs) are now widely used in the modern cataract surgery, providing a good level of visual performance over a range of distances and high postoperative patient satisfaction. We report a case of improved visual quality after shifting the near segment of an asymmetrical multifocal IOL to the superotemporal placement in the dominant eye of a glaucoma patient.

Case summary: A 72-year-old woman with bilateral glaucoma underwent phacoemulsification in the dominant eye (left eye) with implantation of an asymmetrical multifocal IOL. Postoperative uncorrected distance visual acuity (UDVA) was 0.0 logMAR (20/20 Snellen) and uncorrected near visual acuity (UNVA) was 0.1 logMAR (20/25 Snellen). Two weeks later, the patient presented to our clinic with decreased vision due to migration of lens epithelial cells to IOL anterior surface and edema of corneal endothelial cells. Anterior capsule polishing and superotemporal placement of near segment [+3.00 diopter (D) addition (add)] of IOL were performed. As a result, UDVA at the first week and first year after reposition was 0.0 logMAR (20/20 Snellen), and compared with 0.3 logMAR (20/40 Snellen) in the first week, the UNVA was improved to 0.0 logMAR (20/20 Snellen) one year after surgery.

Conclusion: The postoperative inflammatory reaction and lens epithelial cells proliferation were obvious in this glaucoma patient. Capsule polishing and rotation of the lens were beneficial to the patient, which not only enhanced the patient's vision, but also improved the patient's satisfaction. Therefore, glaucoma patients need to be cautious of implanting multifocal IOLs. Placement of a near segment of an asymmetrical multifocal IOL in the dominant eye should be performed on an individual basis.

Keywords: Case report; Cataract surgery; Glaucoma; Patient satisfaction; Rotationally asymmetric refractive multifocal intraocular lens; Visual quality.

Figure 1

Slit lamp examinations 2 wk after phacoemulsification in the left eye. A: The swelling of the corneal endothelium and the proliferation of lens epithelial cells are most pronounced (yellow arrow) over the surface of the intraocular lens; B: The intraocular lens is centered with the near segment placed inferonasally (blue: near segment; green: distant segment).

Figure 2

Intraoperative images of the rotating lens. A: Preoperatively, the light projection of the microscope coincides with the center of the intraocular lens (IOL); B: Separating capsulorhexis opening with a needle; C: Polishing anterior capsule. The laser hole (yellow arrow) after peripheral iridectomy is clearly visible; D: Locating the position of the IOL after rotation with a ring manually; E: Adjusting the position of the IOL with an IOL hook; F: The light projection of the microscope is on the central point of the IOL after rotation.

Figure 3

Slit lamp examinations 1 yr after phacoemulsification in the left eye. A: The intraocular lens (IOL) with the near segment placed superotemporally the first day after rotation in the left eye (blue: near segment; green: distant segment); B: The IOL with the near segment placed superotemporally one year after rotation in the left eye; C: The IOL with the near segment placed inferiorly with slight nasal deviation half a year after phacomulsification in the right eye.