February 13, 2014

BLOG: Primary reverse optic capture for negative dysphotopsia

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Read more from Priya Narang, MS.

The phenomenon of negative dysphotopsia (ND) after a successful cataract surgery can be very distressing both to the surgeon and the patient, who usually complains of visualization of a dark shadow in the temporal field of vision. As reported in the literature, pharmacologic dilation of the pupil relieves the symptoms, whereas constriction of the pupil with miotics accentuates the crisis. Previous studies also showed that an IOL exchange fails to alleviate the symptoms when placed in-the-bag, whereas when an IOL is placed in the sulcus, the symptoms improve.

Reverse optic capture and piggyback IOL implantation in the sulcus have been proposed as a line of treatment for ND.

Postoperatively, when a patient complains of ND, reverse optic capture can be done, which involves a careful separation of the edge of the anterior capsule from the anterior surface of the IOL. It can be done as a primary procedure also in patients who have a history of ND after a surgery in the previous eye.

In primary reverse optic capture after the successful implantation of an IOL in-the-bag, the edge of the optic is lifted with a spatula, an IOL dialer or a hook. The lifted edge of the optic is manipulated and placed above the anterior capsulorrhexis margin. In a one-piece IOL, it is difficult to place the entire 360° of the optic above the anterior capsular rim, yet the 180° opposite edges can be easily placed, with the haptics remaining confined to the capsular bag.

The question of performing a primary reverse optic capture is quite debatable. Because the analysis is purely subjective and depends on the patient, we are uncertain that the patient will experience similar symptoms of ND in the recently operated eye, too. But it has been observed that such patients who have experienced ND in one eye do not experience ND in the other eye when they undergo primary reverse optic capture.