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    Complicated case underscores need for care, preparation


    The back-up plan

    His decision was a three-piece bifocal IOL (AT Lisa 802, Carl Zeiss Meditec) and place it with an optic capture technique.

    “The trifocal IOL I had planned to use has a plate haptic design and would not fit well into the sulcus,” Dr. Kohnen explained. “Therefore, I ordered a bifocal IOL with a three-piece design for implantation with optic capture.”

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    The dropped lens material was removed from the vitreous through 23-gauge pars plana vitrectomy, and the bifocal IOL implanted in the sulcus through a slightly enlarged incision with a posterior optic capture technique.

    On the first day after surgery, the patient had significant corneal edema and distance uncorrected visual acuity (UCVA) was only 0.1. On day 4, she had slight corneal edema and distance UCVA was still only 0.3.

    On day 14, UCVA at distance, intermediate and near was 0.2, 1.0, and 0.63, respectively. However, distance best-corrected visual acuity (BCVA) was 1.0, and refractive error was the cause for the unsatisfactory uncorrected vision. The patient’s refraction was -2.0 -1.0 @103°, and on examination at the slit-lamp after pupil dilation, the cause was determined to be loss of the optic capture.

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    “The patient was quite unhappy because she had a perfect refractive and functional outcome in the first eye,” Dr. Kohnen said.

    Considering the patient desired spectacle independence, she was taken back to the operating room for a reattempt at optic capture, which was completed successfully.  At 1 week after the revision, the patient had only slight residual myopia in both eyes (-0.25 D). Her UCVA at distance, intermediate, and near in the right eye was 1.0, 0.63 and 0.8, respectively.

    “I learned from this case that the combination of a bifocal and a trifocal IOL can work well, and I have used it with success in a subsequent patient,” Dr. Kohnen added.

    More Cataract: Slit beam enhances visualization with corneal opacities


    Thomas Kohnen, MD

    E: [email protected]

    Dr. Kohnen consults, lectures for, and receives research support from Carl Zeiss Meditec and other companies that market IOLs and femtosecond lasers for cataract surgery.

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