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    Novel IOL may be key to preventing negative dysphotopsia


    Evolving design

    Morcher licensed Dr. Masket’s anti-dysphotopic IOL design, and the lens received the CE mark for the first version of the lens (Morcher 90S) in 2014. Five surgeons implanted the 90S lens in 39 eyes.

    Within the series, not 1 eye exhibited negative dysphotopsia, 3 developed capsule block, and 2 developed iris-optic capture where the iris became caught in the margin of the optic groove.

    Among the 48 eyes implanted with the second version of the lens that incorporated fenestration, there were no cases of negative dysphotopsia or capsule block, but optic capture occurred in 5 eyes.

    Figure 3: Version 2 and 3 of Morcher 90S (Masket) IOL. Version 3 on right features an enlarged diameter (6.4 mm) of the anterior portion of the optic.

    “Of the 7 cases that developed optic capture with the first 2 versions of the IOL, 5 required reoperation, and 2 requested explantation,” Dr. Masket said.

    To address the problem of iris-optic capture, Dr. Masket considered the potential causes and determined that the primary culprit was the thickness of the hydrophilic optic.

    “We have not seen iris capture in any eyes where we performed reverse optic capture for implantation of a thin hydrophobic lens,” Dr. Masket said. “When we considered potential cures, we increased the diameter of the anterior part of the optic, reducing the opportunity for the pupil margin to reach the optic edge.  In addition, we added carbachol to the intraoperative protocol to constrict the pupil for the first few days after surgery.”

    Dr. Masket also believes that meticulous wound management is important for preventing iris-optic capture considering that wound leak leading to anterior chamber shallowing may play a role.

    Samuel Masket, MD

    e. [email protected]

    This article is based on presentations delivered by Dr. Masket at the 2018 Cataract Surgery: Telling It Like It Is meeting and the 2017 American Academy of Ophthalmology meeting. Dr. Masket holds U.S. patents on the IOL design and has a licensing agreement with Morcher.

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