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704 Indian Journal of Ophthalmology Volume 66 Issue 5
Figure 5: Postoperative ultrasound biomicroscopy at 12‑month
postsurgery showing no tilt and good centration and stability of
intraocular lens
Conclusion
Isolated PC rupture following blunt trauma with traumatic
cataract with no other additional ocular damage in young
patient is itself a rare entity. More patient recruit, long-term
follow-up and qualitative assessment with patient satisfaction
score are being aimed at in future to further add value to this
report.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/their images and other
clinical information to be reported in the journal. The patients
understand that their names and initials will not be published
and due efforts will be made to conceal their identity, but
anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Commentary: Presbyopia correction
with intraocular lenses
Presbyopia correction remains a great challenge in Cataract and
Refractive Surgery.[1] With each passing moment in the field of
ophthalmology, the expectations of the patient with regards to
functional improvement are waxing. Gone are the days when
a patient reading the last line on your vision chart will always
be satisfied. A common man’s room or his working and living
environment is contracting day by day. Even while driving on
Indian roads, in my personal experience, we are seldom looking
beyond 3–4 m. In my day‑to‑day clinical experience, functional
satisfaction is more in those patients who have residual myopia
or myopic astigmatism.
References
1. Maltzman BA, Pruzon H, Mund ML. A survey of ocular trauma.
Surv Ophthalmol 1976;21:285‑90.
2. Rao SK, Parikh S, Padhmanabhan P. Isolated posterior capsule
rupture in blunt trauma: Pathogenesis and management.
Ophthalmic Surg Lasers 1998;29:338‑42.
3. Thomas R. Posterior capsule rupture after blunt trauma. J Cataract
Refract Surg 1998;24:283‑4.
4. Pavlovic S. Epilenticular intraocular lens implantation in traumatic
cataract with a ruptured posterior capsule. Am J Ophthalmol
2000;130:352‑3.
5. Campanella PC, Aminlari A, DeMaio R. Traumatic cataract and
Wieger’s ligament. Ophthalmic Surg Lasers 1997;28:422‑3.
6. Pushker N, Sony P, Khokhar S, Vardhan P. Implantation of foldable
intraocular lens with anterior optic capture in isolated posterior
capsule rupture. J Cataract Refract Surg 2005;31:1457‑8.
7. Saika S, Kin K, Ohmi S, Ohnishi Y. Posterior capsule rupture by
blunt ocular trauma. J Cataract Refract Surg 1997;23:139‑40.
8. El‑Gendy  A, Rahman  I, Mahmood  U, Nylander  A. Traumatic
rupture of the posterior capsule resulting in complete posterior
prolapse of the lens with subsequent resolution of high myopia.
J Cataract Refract Surg 2006;32:893‑4.
9. Wolter JR. Coup‑contrecoup mechanism of ocular injuries. Am J
Ophthalmol 1963;56:785‑96.
10. Agarwal A, Narang  P, Kumar  DA, Agarwal A. Trocar anterior
chamber maintainer: Improvised infusion technique. J Cataract
Refract Surg 2016;42:185‑9.
11. Weidenthal DT, Schepens CL. Peripheral fundus changes associated
with ocular contusion. Am J Ophthalmol 1966;62:465‑77.
12. Mansour AM, Jaroudi  MO, Hamam  RN, Maalouf  FC. Isolated
posterior capsular rupture following blunt head trauma. Clin
Ophthalmol 2014;8:2403‑7.
13. Choudhary  N, Verma  SR, Sagar  S, Fatima  E. Posterior capsule
rupture with herniation of lens fragment following blunt ocular
trauma. Int Med Case Rep J 2016;9:305‑7.
14. Jacobi PC, Dietlein TS, Lueke C, Jacobi FK. Multifocal intraocular lens
implantation in patients with traumatic cataract. Ophthalmology
2003;110:531‑8.
15. Zeng Y, Fan L, Lu P. Multifocal toric intraocular lens for traumatic
cataract in a child. Case Rep Ophthalmol 2016;7:203‑7.
Recent advances in multifocal intraocular lenses (IOLs),
Trifocal IOLs, and extended range of vision IOLs have
revolutionized the outcomes of cataract surgery. [2] With
advent of these lenses, now the cataract surgery has
expanded into the realm of refractive surgery.[3]
However, at the same time, we come across many
dissatisfied patients after having these lenses implanted.
Insights into the reasons for dissatisfaction of this group
of patients leads me to subdivide them into two groups:
1. Dissatisfied in spite of good refractive outcome
2. Dissatisfied due to poor refractive outcome.
Patients who are dissatisfied in spite of good refractive
outcome complain usually of lack of sharpness in vision,
reduced contrast, and photic phenomena especially during
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May 2018 Case Reports
night driving. Use of these IOLs requires a very good
knowledge of the needs of the patient.[4] The personality of
the patient and his expectation from the surgery has to be
assessed before offering him these premium lenses. Prefer
to write down the keywords, surgeon’s expectations, and
patient’s expectations during the counseling of such patients.
Make sure that these patients read these points on the day of
the surgery too. In the visual pathway, at neural levels, two
disparate images form a combined single image with depth or
stereopsis. Technology till now has tried to correct presbyopia.
Correcting presbyopia with IOL’s increases the complexity
of this pathway with the possible introduction of intraocular
rivalry or relative monovision. The neuroadaptation for using
these lenses lacks studies in depth. Understanding which
patient selection factors are important for neuroadaptation
may improve patient satisfaction.[5]
Second group is the one who are dissatisfied after a poor
refractive outcome. The main reason for this in premium
lenses is the effective lens position, which in itself is an
assumption. The final position where the lens is going to rest,
an unexpected tilt, etc. are the main factors for a refractive
surprise. Development of posterior capsular opacification
and anterior capsular phimosis are not under the control of
surgeons. Minor changes in lens position or decentration
after an neodymium‑doped yttrium aluminum garnet (YAG)
capsulotomy may lead to refractive errors or sometimes
intractable aberrations. According to a study, after 24 months
of implantation of multifocal IOLs, 8.8% developed significant
posterior capsule opacification in hydrophobic IOL group
and 37.2% in hydrophilic IOL group.[6] In another study, the
significant refractive change was noticed in 7% of patients
immediately after YAG capsulotomy postmultifocal IOL
implantation.[7]
Other reasons for poor outcome are inaccurate biometry,
miscalculated surgically induced astigmatism or surgeon’s
factor, ill‑planned incisions, etc. How the wound will heal
in each eye is another assumption.
Hence, a very meticulous workup with assessment of the
needs of the patient, and a very thorough counseling make the
real cocktail of success for the use of premium IOL’s.
Acknowledgment
I would like to thank Dr. Ranjit Singh Dhaliwal and Dr. Chirag
Mittal for their guidance and support.
Kunwar Vikram Singh Dhaliwal
Editor, Journal of ISMSICS, Vice Chairman,
Scientific Committee, ISMSICS, Eye Infirmary,
705
Nabha, Radha Swami Marg,
Nabha ‑ 147 201,
Punjab, India.
E‑mail: editorismsics@gmail.com
References
1. Lichtinger A, Rootman DS. Intraocular lenses for presbyopia
correction: Past, present, and future. Curr Opin Ophthalmol
2012;23:40‑6.
2. S r i n i v a s a r a g h a v a n P , K u m a r D A , A g a r w a l A ,
Parthasarathy A. Extended focal length intraocular lens
implantation in posttraumatic posterior capsular rupture. Indian
J Ophthalmol 2018;66:701-704.
3. Pepose JS. Maximizing satisfaction with presbyopia‑correcting
intraocular lenses: The missing links. Am J Ophthalmol
2008;146:641‑8.
4. Talley‑Rostov A. Patient‑centered care and refractive cataract
surgery. Curr Opin Ophthalmol 2008;19:5‑9.
5. Pepin SM. Neuroadaptation of presbyopia‑correcting intraocular
lenses. Curr Opin Ophthalmol 2008;19:10‑2.
6. G a u t h i e r   L , L a f u m a   A , L a u r e n d e a u   C , B e r d e a u x   G .
Neodymium:  YAG laser rates after bilateral implantation of
hydrophobic or hydrophilic multifocal intraocular lenses:
Twenty‑four month retrospective comparative study. J Cataract
Refract Surg 2010;36:1195‑200.
7. Vrijman  V, van der Linden  JW, Nieuwendaal  CP, van der
Meulen IJ, Mourits MP, Lapid‑Gortzak R, et al. Effect of Nd: YAG
laser capsulotomy on refraction in multifocal apodized diffractive
pseudophakia. J Refract Surg 2012;28:545‑50.
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Cite this article as: Singh Dhaliwal KV. Commentary: Presbyopia correction
with intraocular lenses. Indian J Ophthalmol 2018;66:704-5.