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Argon laser iridoplasty viable option to correct minimally decentered multifocal IOLs
 Eric D. Donnenfeld |
WAILEA, Hawaii — In cases of minimally decentered multifocal IOLs, argon laser iridoplasty can effectively improve vision, a presenter said here.
Eric D. Donnenfeld, MD, presented his technique and results of iridoplasty to effectively re-center the pupil in these cases.
"Decentration of a multifocal IOL is a completely different animal from decentration of a conventional lens," Dr. Donnenfeld said at Hawaiian Eye 2009. "Multifocal IOLs can induce optical aberrations even when they are minimally decentered."
In these cases, Dr. Donnenfeld said he and his colleagues have been using a technique that places argon laser spots in the mid-periphery, using 500 mW of energy and a diameter of 500 µm for a duration of 500 milliseconds.
"We use no contact lens, and for blue irises you may need to use a little more power, and for dark brown a little less," he said.
"By re-centering the pupil like this, we have had some very good success in some of these patients," he said.
Photomydriasis with the argon or diode laser represents an effective procedure for re-shaping the pupil in patients with multifocal IOLs. It can be used to symmetrically enlarge the pupil and improve near vision with the ReZoom (in which the central zone is distance-dominant and the first peripheral zone is near-dominant) and apparently also to asymmetrically enlarge the pupil to align it with the center of the IOL and improve both distance and near vision with the ReSTOR (in which the central zone splits distance and near focal lengths). A thorough description of photomydriasis can be found in Thomas JV. Pupilloplasty and photomydriasis. In: Belcher CD, Thomas JV, Simmons RJ, eds. Photocoagulation in glaucoma and anterior segment disease. Baltimore: Williams & Wilkins, 1984:150-157.
– Mark Packer, MD, FACS
Drs. Fine, Hoffman & Packer Ophthalmologists, Eugene,
Ore.