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Negative dysphotopsia may result from several factors
J Cataract Refract Surg. 2008;34(10):1699-1707.
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Corneal edema associated with a beveled temporal incision may contribute to transient negative dysphotopsia after cataract surgery and IOL insertion.
In patients whose shadows disappear in the first 8 weeks after surgery, edema associated with a clear or near-clear corneal incision may explain the shadows. In patients with permanent symptoms, shadows may result from interaction between IOL optics and unique anatomic features.
“This study challenges the accepted dogma and raises the possibility that temporal negative dysphotopsia is multifactorial,” the study author said.
The study included 250 eyes that underwent cataract removal with implantation of a single-piece acrylic IOL (SN60WF or SN60AT, Alcon). Near-clear, three-plane 2.75-mm corneal incisions were created superotemporally in right eyes, temporally in left eyes.
One day after surgery, negative dysphotopsia was reported in 38 eyes (15.2%). At 1 year, shadows persisted in seven eyes of five patients (3.2%), all of whom had undergone bilateral surgery.
Among patients with shadows at 1 year postop, common anatomic features included shallow orbit, prominent globe, a space greater than 0.45 mm between the iris and anterior surface of the IOL, and transparent peripheral capsule.
Patients with permanent shadows had uncorrected visual acuity of 20/25 or better and were generally satisfied with surgical outcomes.
Negative dysphotopsia is a relatively common postoperative complication that may have an association with temporally oriented incisions only in the early postoperative period. This condition occurs with almost all IOLs and with incisions located in any quadrant.
The only information that one might take from this in dealing with their patients is to encourage patients that in the great majority, these symptoms will abate over a short period of time.
Negative dysphotopsia remains an enigma. Long-term cases may require secondary surgery. I have had success either in implanting a second lens in the ciliary sulcus on top of the original lens or transferring the original lens to the ciliary sulcus. At this moment, we do not have an objective test to evaluate patient complaints, and we rely solely upon patient observations to explain the condition to us. It remains a problem for us both in terms of cause and effective treatment, although surgically, I have helped a number of patients with this condition.
— Samuel Masket, MD
Clinical professor of
ophthalmology at UCLA David Geffen School of Medicine