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• W2044160987 abstract "We evaluated the results of implanting the AMO® Array® multifocal intraocular lens (IOL) in an unselected series of 510 eyes having phacoemulsification. The target refraction in these eyes was emmetropia ± 0.25 diopter (D). A surprise myopic error of −1.00 D or more spherical equivalent was noted in 66 eyes during the first refraction between 2 and 6 weeks postoperatively. Forty-eight of the eyes were available for a second refraction, which was carried out at a median of 6 months (range 1.5 to 24 months). The mean spherical equivalent refractive error at the first and second postoperative refractions was −2.38 D (range −1.00 to −4.75 D) and −1.38 D (range +1.75 to −2.75 D), respectively. Calculation of the shift in the spherical equivalent at the second refraction revealed no change in refraction in 6 eyes (12.5%), a further myopic shift (range −0.12 to −0.50 D) in 6 eyes (12.5%), and a hyperopic shift (range 0.12 to 4.00 D) in the remaining 36 eyes (75.0%). Details of the degree of hyperopic shift in these 36 eyes are shown in Figure 1. None of the 48 eyes achieved uncorrected functional multifocal vision (6/12 and N8 or better) at the first refraction. However, 32 eyes demonstrated a spontaneous refractive shift of +0.50 D or more leading to good uncorrected functional vision in 23 (64%) of the 36 eyes showing a hyperopic change at the time of the second refraction.Figure 1.: (Kamath) Degree of hyperopic shift between the first and second refractions (n = 36).The retrospective nature of our series implies that we can only make a “best guess” about the mechanism involved. We propose that an early postoperative capsular bag distension induced the early myopic error and the hyperopic shift was due to its spontaneous resolution. Small case series and individual case reports have described resolution of variable degrees of myopia induced by capsular bag distension either spontaneously or after neodymium:YAG laser capsulotomy1–3 or surgical aspiration of viscoelastic material from the capsular bag.4 The incidence of this syndrome is not known. One report2 quotes an approximate incidence of 1%. In our series, after excluding the eyes having simultaneous filtration (4) or vitrectomy (1) procedures, the incidence of capsular bag distension may be up to 5.3% (27/510 eyes). Although not specifically looked for, capsular bag distension was noted during the first postoperative refraction visit in 4 eyes, and this had resolved at the second refraction. All 4 eyes showed a hyperopic shift in excess of 2.00 D. Previous reports have presented only cases with large refractive shifts. Minor degrees of capsular bag distension, with smaller amounts of induced myopia, are easily overlooked, but this assumes importance when a multifocal IOL is used with the goal of spectacle independence. Postoperative refractive errors of the magnitude we have noted (mean −2.38 D) is usually attributed to a biometric or IOL labeling error. This would require IOL exchange or a secondary piggyback IOL if the patient is to enjoy the benefits of multifocality. However, a large proportion of eyes with observed unintended myopia spontaneously improved. It is thus important to be aware of this phenomenon. Attempts to exchange the IOL or implant a secondary piggyback IOL should be delayed and performed only after capsular bag distension is ruled out or treated and refraction has stabilized. In our study, this did not occur until 2 months postoperatively. Girish G Kamath DO, MS, DNB, FRCSed, FRCOphth Somdutt Prasad MS, FRCSed Yogesh J Patwala MS, MRCOphth Russell P Phillips DO, FRCSed, FRCOphth, MD aWirral, United Kingdom" @default.
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• W2044160987 date "2001-05-01" @default.
• W2044160987 modified "2023-09-25" @default.
• W2044160987 title "Postoperative Myopia with Subsequent Hyperopic Shift After Phacoemulsification and Multifocal IOL Implantation" @default.
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• W2044160987 doi "https://doi.org/10.1016/s0886-3350(01)00827-6" @default.
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