American journal of ophthalmology · 2022
Randomized Controlled Trial of Intraocular Lens Orientation for Dysphotopsia.
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Pamulapati Saagar V, Saeed Jordan M, Pompey Nichole, Gomez Kayéromi D, Vakharia Mitul R
Аннотация
PURPOSE: To evaluate whether orientation of the optic-haptic junction of an intraocular lens (IOL) during cataract surgery could decrease the incidence and/or severity of positive and negative dysphotopsia.
DESIGN: Prospective, randomized controlled trial.
METHODS: A total of 163 patients (326 eyes) in a private practice scheduled to have bilateral implantation of a Tecnis monofocal IOL (ZCB00) (Johnson & Johnson Vision) were randomly assigned to have the optic-haptic junction positioned vertically, horizontally, superonasally, or inferonasally. Patients with known visual field defects or best-corrected vision less than 20/80 were excluded. Patients were surveyed for positive and negative dysphotopsia symptoms at 1 week and 4-6 weeks after surgery. Patients were blinded to the orientation whereas researchers were not. Data were analyzed to compare the differences in positive and negative dysphotopsia incidence and severity.
RESULTS: IOL oriented vertically in 82 eyes (25.2%), horizontally in 72 eyes (22.1%), superonasally in 94 eyes (28.8%), and inferonasally in 78 eyes (23.9%). Significant differences were noted between orientations in incidence of negative dysphotopsia at 1 week postoperatively (P = .019) and 4-6 weeks postoperatively (P = .002). Patients in the superonasal group had the worst outcome at both time periods, and the horizontal group had the best outcome at 4-6 weeks. No differences were noted for positive dysphotopsia incidence or severity.
CONCLUSIONS: The orientation of the optic-haptic junction of a monofocal IOL was significantly associated with incidence of negative dysphotopsia after surgery, with the horizontal orientation performing best at 4-6 weeks.
DESIGN: Prospective, randomized controlled trial.
METHODS: A total of 163 patients (326 eyes) in a private practice scheduled to have bilateral implantation of a Tecnis monofocal IOL (ZCB00) (Johnson & Johnson Vision) were randomly assigned to have the optic-haptic junction positioned vertically, horizontally, superonasally, or inferonasally. Patients with known visual field defects or best-corrected vision less than 20/80 were excluded. Patients were surveyed for positive and negative dysphotopsia symptoms at 1 week and 4-6 weeks after surgery. Patients were blinded to the orientation whereas researchers were not. Data were analyzed to compare the differences in positive and negative dysphotopsia incidence and severity.
RESULTS: IOL oriented vertically in 82 eyes (25.2%), horizontally in 72 eyes (22.1%), superonasally in 94 eyes (28.8%), and inferonasally in 78 eyes (23.9%). Significant differences were noted between orientations in incidence of negative dysphotopsia at 1 week postoperatively (P = .019) and 4-6 weeks postoperatively (P = .002). Patients in the superonasal group had the worst outcome at both time periods, and the horizontal group had the best outcome at 4-6 weeks. No differences were noted for positive dysphotopsia incidence or severity.
CONCLUSIONS: The orientation of the optic-haptic junction of a monofocal IOL was significantly associated with incidence of negative dysphotopsia after surgery, with the horizontal orientation performing best at 4-6 weeks.