Inadvertent implantation of a reversed-optic Tecnis ZM900 multifocal intraocular lens: case report

Hida, Wilson Takashi; Motta, Andréa Rodrigues; Nakano, Celso Takashi; Tzelikis, Patrick Frensel

doi:10.1590/s0004-27492012000600012

Cited by 2 publications

(3 citation statements)

References 9 publications

(10 reference statements)

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“…Some publications written as case reports explain the possible complications related to inverted IOL implantation. These are capsular block syndrome [30], and consequently glaucoma [31], posterior capsule opacification, as a consequence of the lack of a 360 degrees square edge on the anterior surface of the IOL [15], and refractive error due to the incorrect lens placement [30]. Haptic design is a critical factor in axial misplacement of the flipped IOL.…”

Section: Discussionmentioning

confidence: 99%

“…However, nowadays the market trend is Optical Quality Variation of Different Intraocular Lens Designs in a Model Eye to design IOLs with no haptic angulation, and even with an axially displaced IOL the refractive error can be easily compensated with any kind of refractive correction. Some authors have described different techniques to flip an IOL which has been implanted in the upside-down position [32,33], but the minor consequences that a wrong implanted IOL produces in patients lead to implementing conservative management during surgery, leaving the IOL flipped [30].…”

Section: Discussionmentioning

confidence: 99%

“…Haptic design is a critical factor in axial misplacement of the flipped IOL. Inverting the optic also reverses the haptic angulation, so the lens will be displaced towards the cornea [30]. However, nowadays the market trend is Optical Quality Variation of Different Intraocular Lens Designs in a Model Eye to design IOLs with no haptic angulation, and even with an axially displaced IOL the refractive error can be easily compensated with any kind of refractive correction.…”

Section: Discussionmentioning

confidence: 99%

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Optical Quality Variation of Different Intraocular Lens Designs in a Model Eye: Lens Placed Correctly and in an Upside-Down Position

et al. 2023

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Introduction: Intraocular lenses (IOLs) may lose their optical quality if they are not correctly placed inside the capsular bag once implanted. One possible malpositioning of the IOL could be the implantation in an upside-down position. In this work, three aspheric IOLs with different spherical aberration (SA) have been designed and numerically tested to analyse the optical quality variation with the IOL flip, and misalignments, using a theoretical model eye. Methods: Using the commercial optical design software OSLO, the effect of decentration and tilt was evaluated by numerical ray tracing in two conditions: IOL in their designed position and flipped. The Atchison theoretical model eye used. Seven IOL designs of +27.00 diopters were used: a lens with negative SA to correct the corneal SA, a lens to partially correct the corneal SA and a lens to not add any SA to the cornea (aberration-free IOL). These lenses were designed with the aspherical surface located on the anterior and posterior IOL surface. A lens with no aspherical surfaces was also included. For the optical quality analysis, the Modulation Transfer Function (MTF) and Zernike wavefront aberration coefficients of defocus, astigmatism and primary coma were used. Results: Off-centering and tilting the IOL reduced overall MTF values, and increased wavefront aberration errors. With the IOL correctly positioned within the capsular bag, an aberration-free IOL is the best choice for maintaining optical quality. When the IOL is flipped inside the capsular bag the optical quality changes, with the aberration-free IOL and the IOL without aspheric surfaces providing the worst results. With the lens in an upside-down position, an IOL design to partially correct corneal SA shows the best optical quality results in decentration and tilt. Conclusion: The aberration-free IOL is the best choice when minimal postoperative errors of decentration or tilt are predicted. With IOL flip, the negative SA lens design is the best choice, regarding the root mean square wavefront aberrations. However, in a proper IOL implantation, the IOL designed to partially compensate the corneal SA including asphericity on its posterior surface is the better possible option, even in the presence of decentration or tilt.

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