Consultation section: Cataract
After the unsuccessful attempt at reverse optic capture in the right eye, I suggest a step-by-step approach for treating negative dysphotopsia. First, I would try to perform a nasal Nd:YAG laser anterior capsulotomy.1 If this were not successful, I would continue with secondary piggyback IOL placement in the sulcus. Some excellent add-on IOLs for ciliary sulcus implantation are available in Europe. Studies2,3 have found that this a good method to treat negative dysphotopsia. If this failed, I would explant the add-on and the primary IOL and implant a 3-piece IOL into the ciliary sulcus. In Europe, individually manufactured foldable toric 3-piece posterior chamber IOLs (PC IOLs) (Humanoptics AG) are available. If these IOLs are not available, a foldable spherical 3-piece PC IOL can be implanted in the ciliary sulcus and the remaining astigmatism can be corrected using a corneal laser.
Cyanopsia after UV light–filtering IOL implantation is a common finding4; however, in my experience, in most cases the problem resolves spontaneously in a few weeks. In case of permanent cyanopsia, I usually suggest cataract surgery in the fellow eye, which solves the problem in almost all cases. In this special case, if wearing the yellow-tinted RGP contact lens is comfortable for the patient after the first-eye surgery, surgery on the second eye can be delayed. If not, refractive lens exchange with implantation of a Morcher 90S bag-in-the-lens IOLA can be performed. This IOL has a Conformité Européenne mark and seems to be perfect in preventing negative dysphotopsia. I have implanted this model in 50 eyes and no patient had negative dysphotopsia symptoms, although 3 of them had it earlier with another 1-piece in-the-bag IOL in the first operated eye.
1. Folden DV. Neodymium:YAG laser anterior capsulectomy: surgical option in the management of negative dysphotopsia. J Cataract Refract Surg
2. Ernest PH. Severe photic phenomenon. J Cataract Refract Surg
3. Masket S, Fram NR. Pseudophakic negative dysphotopsia: surgical management and new theory of etiology. J Cataract Refract Surg
4. Davison JA, Patel AS, Cunha JP, Schwiegerling J, Muftuoglu O. (2011). Recent studies provide an updated clinical perspective on blue light-filtering IOLs. Graefes Arch Clin Exp Ophthalmol, 249
, 957-968, Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124647/pdf/417_2011_Article_1697.pdf
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