Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2022; 10(20): 7013-7019
Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.7013
Secondary positioning of rotationally asymmetric refractive multifocal intraocular lens in a patient with glaucoma: A case report
Cong Fan, Yi Zhou, Jian Jiang
Cong Fan, Yi Zhou, Jian Jiang, Department of Ophthalmology, Xiangya Hospital Central South University, Changsha 410000, Hunan Province, China
Author contributions: Fan C was a major contributor in acquisition of the data, literature search, and manuscript draft; Zhou Y analyzed and interpreted the imaging findings, and contributed to manuscript drafting; Jiang J was the patient’s surgeon, provided the concept and design, and was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported by National Natural Science Foundation of China, No. 81974130; and Natural Science Foundation of Hunan Province, China, No. 2020JJ4882.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian Jiang, PhD, Associate Professor, Department of Ophthalmology, Xiangya Hospital Central South University, No. 87 Xiangya Road, Changsha 410000, Hunan Province, China. jiangjianxy@126.com
Received: November 17, 2021
Peer-review started: November 17, 2021
First decision: April 13, 2022
Revised: April 20, 2022
Accepted: May 27, 2022
Article in press: May 27, 2022
Published online: July 16, 2022
Abstract
BACKGROUND

Asymmetric multifocal intraocular lenses (IOLs) are now widely used in the modern cataract surgery, providing a good level of visual performance over a range of distances and high postoperative patient satisfaction. We report a case of improved visual quality after shifting the near segment of an asymmetrical multifocal IOL to the superotemporal placement in the dominant eye of a glaucoma patient.

CASE SUMMARY

A 72-year-old woman with bilateral glaucoma underwent phacoemulsification in the dominant eye (left eye) with implantation of an asymmetrical multifocal IOL. Postoperative uncorrected distance visual acuity (UDVA) was 0.0 logMAR (20/20 Snellen) and uncorrected near visual acuity (UNVA) was 0.1 logMAR (20/25 Snellen). Two weeks later, the patient presented to our clinic with decreased vision due to migration of lens epithelial cells to IOL anterior surface and edema of corneal endothelial cells. Anterior capsule polishing and superotemporal placement of near segment [+3.00 diopter (D) addition (add)] of IOL were performed. As a result, UDVA at the first week and first year after reposition was 0.0 logMAR (20/20 Snellen), and compared with 0.3 logMAR (20/40 Snellen) in the first week, the UNVA was improved to 0.0 logMAR (20/20 Snellen) one year after surgery.

CONCLUSION

The postoperative inflammatory reaction and lens epithelial cells proliferation were obvious in this glaucoma patient. Capsule polishing and rotation of the lens were beneficial to the patient, which not only enhanced the patient's vision, but also improved the patient's satisfaction. Therefore, glaucoma patients need to be cautious of implanting multifocal IOLs. Placement of a near segment of an asymmetrical multifocal IOL in the dominant eye should be performed on an individual basis.

Keywords: Cataract surgery, Glaucoma, Rotationally asymmetric refractive multifocal intraocular lens, Visual quality, Patient satisfaction, Case report

Core Tip: Based on the design concept of asymmetric region refraction, the placement of asymmetric multifocal intraocular lenses (IOLs) is particularly important. Here, we report the case of a glaucoma patient undergoing cataract surgery with an asymmetric multifocal IOL implanted in the dominant eye. After 2 wk, the lens epithelial cells proliferated rapidly and visual acuity decreased significantly, which was recovered after capsular polishing combined with IOL rotation. By reporting this case, we hope to provide new insights into the implantation of asymmetric multifocal IOLs in patients with glaucoma.