Intraocular lens exchange in patients with negative dysphotopsia symptoms

PURPOSE: to evaluate the results of intraocular lens (IOL) exchange in cases of severe negative dysphotopsia and to measure the distance between the iris and the IOL optic using ultrasound biomicroscopy (UBM). SETTING: Szent Rokus Hospital and Eye Clinic, Semmelweis University, Budapest, Hungary. METHODS: Data of patients with major negative dysphotopsia symptoms after phacoemulsification with IOL implantation were reviewed retrospectively. In cases in which IOL exchange was performed to diminish the symptoms, the distance between the iris and the anterior surface of the IOL optic was measured by UBM and compared with that in a group of nonsymptomatic pseudophakic patients (control group). RESULTS: in 3806 cataract procedures, 5 eyes (4 patients) had severe negative dysphotopsia symptoms. Intraocular lens exchange was performed in 3 cases. In 1 case, the secondary IOL was implanted in the reopened capsular bag and the symptoms persisted. In 2 cases, the secondary IOL was implanted in the ciliary sulcus and the symptoms resolved. On UBM, the mean iris optic distance was 0.45 mm +/- 0.07 (SD) in the symptomatic group, 0.59 +/- 0.29 mm in the control group (n = 21) (P = .353), and 0.00 mm in the sulcus-fixated group. CONCLUSIONS: The iris optic distance was not statistically significantly different between eyes with severe negative dysphotopsia symptoms and nonsymptomatic eyes. However, when IOL exchange reduced the iris-IOL distance, the severe negative dysphotopsia symptoms resolved.