Strategies for performing a reverse optic capture of toric IOL
Steven Dewey, MD, shares his experience with a recent patient case when a lens rotated. A possibility for why this may have happened is the lens was not stable in the bag.
By Steven Dewey, MD, Special to Ophthalmology Times
Steven Dewey, MDColorado Springs, CO-A few months ago, I performed femtosecond laser-assisted cataract surgery on the left eye of a 67-year-old female patient, and implanted a toric lens (SN6AT9, Alcon Laboratories). Surgery was uneventful and the IOL was nicely aligned at the close of the case.
On the second day, the patient had a spike in IOP. I tapped the sideport incision to relieve pressure and placed the patient on brimonidine tartrate/timolol maleate (Combigan, Allergan) twice a day.
A few days later, closing in on the 1-week mark, she complained of blur. Ray tracing showed the IOL had rotated 69Ë counterclockwise (Figure 1).
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Her refraction was now +2.75 -8.34 x 33. I wanted to give the capsular bag a chance to contract so we waited another 2 weeks to reposition the lens. At that point, the lens was easily rotated back into position and was perfectly aligned when I closed the eye, just as it had been at the initial surgery. This time I put the patient on Combigan and oral Diamox for 1 week as a preventive measure and she did not have an IOP spike.
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However, she returned 2 weeks later with the same symptoms of blur: The lens had rotated out of position a second time, clockwise again, but this time only 44Ë. This time, partly due to the patient’s schedule, we waited another 2 months for the repositioning. I found the lens was still surprisingly mobile in the bag, with less fibrosis than expected.
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I re-aligned the lens as before, but this time, tucked the nasal capsule under the IOL and then tucked the temporal capsule under the lens for a reverse optic capture (Figure 2).
Her vision improved to J1 at near with a -2.75 + 0.75 x 070 refraction. This (fortunately) very understanding patient was quite satisfied with the final result, and her lens has remained perfectly positioned ever since. In fact, 3 weeks after the second repositioning, we proceeded with toric lens surgery on her right eye, with no further rotational issues.
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