Investigators evaluated the effectiveness of curative and preventative surgical strategies for negative dysphotopsia.

They included patients with self-reported chronic negative dysphotopsia who underwent corrective surgery. The preventative group included symptomatic patients requiring cataract surgery in a contralateral eye. The primary outcome measure was improvement of negative dysphotopsia by 3 months after surgery.

Outcomes

Of the 40 eyes in the therapeutic group, 76.6% had acrylic IOLs, 23.4% were silicone, and all were bag-fixated. Negative dysphotopsia was associated with acrylic or silicone IOLs of either square- or round-edge design. Anterior capsule overlap on the IOL surface was the key factor inducing negative dysphotopsia.

Successful outcomes for each surgical strategy were as follows: bag-to-bag IOL exchange (0/5), a reduction in posterior chamber depth with iris suture fixation of the bag–haptic complex (0/1), piggyback secondary IOL (8/11), secondary reverse optic capture (21/22), ciliary sulcus posterior chamber IOL exchange (7/8) and primary reverse optic capture (21/21).

Of the 21 eyes in the preventative group, 10 did not require surgery for the symptomatic eye.

Limitations of this study include the retrospective design, the subjective nature of reporting negative dysphotopsia resolution and the disproportionate number of patients in each group.

This is the most wide-reaching, logical and helpful paper to date on negative dysphotopsia. The findings suggest that surgeons should consider reverse optic capture for all patients with recalcitrant negative dysphotopsia.

There is also a need for innovative IOL designs that can prevent negative dysphotopsia yet avoid the potential complications of reverse optic capture and ciliary sulcus placement. The authors of this study have developed an IOL containing a groove designed to receive the anterior capsulotomy, which is currently in clinical trials in Europe.

—Lisa B. Arbisser, MD