Black-on-black secondary occlusive IOL implantation to alleviate enigmatic light perception through a black IOL.

UNLABELLED: A 61-year-old woman presented with an 18-year history of a debilitating ghosting phenomenon and light perception in her right eye following implantation of a Morcher black intraocular lens (IOL) for intractable diplopia. On 5 occasions, she was referred to hospital ophthalmology, repeatedly requesting right optic nerve transection to alleviate the symptoms. The mechanism of light perception across the occlusive IOL remained enigmatic, preventing appropriate management. Morcher occlusive IOLs transmit high levels of near infrared (IR) light, which may cause light perception under photopic conditions by long-wavelength cone photoreceptors. Considering this, we implanted a near IR-blocking Artisan black iris-claw IOL anterior to the Morcher occlusive IOL. Postoperatively, the light perception and ghosting disappeared and the visual quality of life score (VF-14) increased from 41 to 86. We suggest consideration of this surgical approach of black-on-black IOL implantation for patients with refractory light perception despite implantation of a near IR-transmitting occlusive IOL. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Iris-claw intraocular lenses to correct aphakia in the absence of capsule support.

PURPOSE: To evaluate the indications, postoperative visual efficacy, and complication rate after intraocular implantation of an iris-claw aphakic intraocular lens (IOL). SETTING: Oxford Eye Hospital, Oxford, United Kingdom. DESIGN: Case series. METHODS: This chart review comprised eyes with no capsule support that had anterior iris-fixation IOL implantation for aphakia between 2001 and 2009. RESULTS: The study comprised 116 eyes (104 patients). Iris-claw IOLs were inserted during primary lens surgery in 18 eyes (15.5%), during an IOL exchange procedure for dislocated posterior chamber IOLs in 19 eyes (16.4%), and as a secondary procedure in 79 eyes (68.1%). The mean follow-up was 22.4 months (range 3 to 79 months). The final corrected distance visual acuity (CDVA) was 6/12 or better in 68.9% of all eyes and in 47 of 53 eyes (88.7%) with no preoperative comorbidity. Complications included wound leak requiring resuturing in 2.6% of eyes, postoperative intraocular pressure rise in 9.5% of eyes (glaucoma escalation 0.8%), and cystoid macular edema in 7.7% of eyes (0.8% chronic). Iris-claw IOL subluxation occurred in 6.0% of eyes from 5 days to 60 months postoperatively; all the IOLs were repositioned. Corneal decompensation occurred in 1.7% of eyes; 0.8% had retinal detachments. CONCLUSIONS: Iris-claw IOL implantation for aphakia gave a good visual outcome and can be used for a wide range of indications. Postoperative complication rates were comparable to, if not better than, those with conventional anterior chamber IOLs. Correct implantation technique is critical in avoiding postoperative IOL subluxation.