Unilateral dysphotopsia after bilateral intraocular lens implantation using the AR40e IOL model: case report

Abstract

The authors report a recent complication during the postoperative period of cataract surgery. A patient was submitted to cataract surgery in both eyes with IOL implantation (Sensar) inside the capsular bag. The postoperative period of right eye was uneventful, however, in the left eye the patient noted a dark shadow at the temporal visual field at the first postoperative week. This diagnosis was confirmed with the presence of a temporal scotoma revealed by the computerized visual field (first reported in this study) and also reducing the pupil area with miotic drops. The treatment of this complication was performed by using brimonidine tartrate and after 6 months this symptom completely disappeared as confirmed by the computerized visual field. The treatment should be based on reducing the pupil area with miotic drops and we also recommend to observe these cases until the 6th postoperative month before indicating an IOL exchange since the capsular edge that overlaps the IOL may opacify creating an optical barrier reducing or eliminating negative dysphotopsia.

Ursachen, Diagnose und Therapie der negativen Dysphotopsie

“…Dieser Schatten scheint eher nicht bei 90°temporal, wie in der Literatur bisher überwiegend be-schrieben, sondern zentraler zu liegen. Marques und Marques berichteten 2007 [15] über eine ähnliche Beobachtung; mit dem Humphrey-Gesichtsfeld fanden sie bei einem ND-Patienten kurzfristig ein absolutes Skotom temporal oben, etwa 10°vom Zentrum entfernt. Dieser Befund wird von späteren Autoren angezweifelt, so auch von Makhotkina und Mitarbeitern [16].…”

“…Masket und Fram [27], Arnold [32], Davison [20], Olson [4], Marques und Marques [15] und Henderson und Geneva [5] diskutierten kontrovers, ob miotische oder mydriatische Augentropfen helfen könnten, ohne überzeugende Zahlen zu liefern.…”

Pseudophakic Dysphotopsia

“…Various approaches to negative dysphotopsia were made in search for possible solutions [7,13,19,20,[26][27][28][29][30][31][32][33] A program with a three-dimensional model eye was used to study the edges (straight or truncated and/or round) of IOL, through an analysis of ray tracing emanating from the light. The rays that reach the straight edge cause reflection of the light at an angle greater than 30 to 40-90° or more, maximizing the intensity of the reflexes, since they reach very close to each other and reflect on the opposite side of the peripheral retina as a dark shadow described by the patients as an arch or crescent (negative dysphotopsia).…”

Is the Memory Effect of the Blind Spot Involved in Negative Dysphotopsia after Cataract Surgery?

“…In some cases, however, they persist for a longer time period and patients are severely disturbed and insist on surgical interventions such as intraocular lens (IOL) explantation or implantation of an add-on IOL. Up to now, only F. F. Marques and D. M. V. Marques quantified these optical phenomena clinically by performing visual field measurements [ 9 ]. They described a scotoma in the superior-temporal visual field at an eccentricity of about 20°, which improved upon pharmacological miosis.…”

“…The published literature [ 1 , 5 ] reports an incidence between 0.2% and 20%. Photic effects were first described with PMMA lenses [ 11 – 13 ]; however, most authors reported ND with acrylic or silicone intraocular lenses [ 1 , 5 , 9 , 10 , 14 – 20 ].…”