One-year visual outcome of secondary piggyback pinhole device implantation in pseudophakic eyes with irregular corneal astigmatism and iris trauma

Abstract

Purpose Retrospective case series evaluating the efficacy and safety of implanting XtraFocus ™ pinhole device in pseudophakic patients with irregular corneal astigmatism with concurrent or standalone iris defect. Methods Electronic case records were searched for: uncorrected distance visual acuities (UDVA) and corrected distance visual acuities (CDVA), automatic or manifest refraction and spherical equivalent (SE). All main outcomes were evaluated preoperatively and postoperatively at 1, 3, 6, 9 and 12 months, along with patients’ satisfactory outcome and complications. Results Eleven pseudophakic eyes of 11 patients with a mean age of 54 (range 27–81) years were included. Median UDVA improved significantly from logMAR 0.7 (range 0.1–1.22) pre-operatively to 0.4 (range 0–1.3) at 1-month ( p = 0.002); median CDVA remained unchanged at logMAR 0.4 (range 0–0.1) pre-operatively and 0.4 (range 0–0.8) at 1-month ( p = 0.36). There were no significant statistical differences in both UDVA and CDVA between the post-operative periods. Ten patients (90.9%) had initial UDVA improvement at 1-month post op. Eight (72.7%) patients expressed satisfaction with improved vision or reduction of glare/halos. Three (27.3%) patients had unsatisfactory visual outcome resulting in 2 requested for implant explantation due to worsening of glare and distressing floaters. Conclusions XtraFocus ™ is effective in improving vision or reducing glare in pseudophakic patients with irregular corneal astigmatism or intragenic iris trauma, with over 70% expressed satisfactory outcome. Disturbing floaters and glare preclude its use in some resulting in implant explantation.

Review of surgical devices using small aperture optics

“…[ 8 ] Near vision enhancement in pseudophakes with monofocal IOLs and dysphotopsia reduction in eyes with multifocal IOLs may be secondary indications. [ 32 ] The XtraFocus device is black making it beneficial for patients with large iris defects [ Figure 2e and f ]. Patients with good fitting rigid gas-permeable contact lens who tolerated them well were excluded from implantation.…”

“…[ 6 ] In the study by Ho et al ., all their patients had poor vision or glare preoperatively due to a standalone iris defect or coexisting irregular astigmatism and iris defect. [ 32 ] After XtraFocus implantation, 90.9% had better UDVA and 72.7% reported satisfaction with the improved vision or lessened glare. [ 32 ] The refractive and visual acuity outcomes of the XtraFocus IOL publications are summarized in [ Table 6 ].…”

“…[ 32 ] After XtraFocus implantation, 90.9% had better UDVA and 72.7% reported satisfaction with the improved vision or lessened glare. [ 32 ] The refractive and visual acuity outcomes of the XtraFocus IOL publications are summarized in [ Table 6 ].…”

“… a First author and year study was published, b XtraFocus device implanted in the ciliary sulcus of pseudophakic patients with monofocal IOL, c XtraFocus device implanted in the capsular bag at the time of cataract surgery together with a primary IOL, d Bilateral XtraFocus device implanted in the ciliary sulcus of pseudophakic patients or in the ciliary sulcus or capsular bag of phakic patients right after the cataract surgery or refractive lens exchange, e Binocular values, f XtraFocus device implanted in the ciliary sulcus of pseudophakes with standalone iris defect or iris defect with coextisting corneal irregular astigmatism, † All studies include patients with irregular corneal astigmatism, and all values were from the 1 year postoperative follow-up. [ 6 8 32 33 ] CDVA=Corrected distance visual acuity, CNVA=Corrected near visual acuity, F/U=Follow-up, J=Jaeger, n =Number of eyes, NA=Not available, SE=Spherical equivalent, UDVA=Uncorrected distance visual acuity, UNVA=Uncorrected near visual acuity …”

“…[ 33 ] In another study, the patient who had XtraFocus explantation had complete resolution of the persistent glare and halos after device removal. [ 32 ] Dilated infrared photography showed no interlenticular opacification for up to 4 years postoperatively. [ 6 ] The authors noted that this was possibly due to the posterior concave shape of the IOL that reduced contact with the other IOL inside the bag while its central hole allowed exit of lens cells through aqueous movement.…”