Occlusive IOLs for intractable diplopia demonstrate a novel near-infrared window of transmission for SLO/OCT imaging and clinical assessment

Application of Soft Directional Prismatic Contact Lenses to Correct Diplopia

PURPOSE

To verify whether diplopia due to a small-angle strabismus within 8 prism diopters (PD) could be corrected by applying soft directional prismatic contact lenses, obtaining higher comfort and quality of vision for the patients.

METHODS

A prospective study was undertaken by enrolling consecutive patients affected by vertical and/or horizontal diplopia and small-angle strabismus within 8 PD. The patients were tested for best corrected visual acuity, refraction, cover test for near and for distance, ocular motility test, prismatic fit test, corneal topography, tear film evaluation, binocular vision test, head position evaluation, retinography, and optical coherence tomography of the posterior and anterior segment. Custom soft contact lenses, made in Benz G5X material, were designed and developed for this study. All patients were first corrected with prismatic glasses according to their degree of strabismus and ametropia. Then they were asked to wear custom-made directional prismatic contact lenses with appropriate simultaneous correction of strabismus and ametropia. The patients were then asked to answer whether the comfort and quality of vision was higher with directional prismatic contact lenses or prismatic glasses.

RESULTS

Eight patients were enrolled with different causes of diplopia caused by a strabismus of 8 PD or less. The soft directional prismatic contact lenses could resolve diplopia in 100% of patients. All patients reported greater comfort and quality of vision with directional prismatic contact lenses.

CONCLUSIONS

The study demonstrated that diplopia resulting from an angle of strabismus within 8 PD can be corrected through the use of soft directional prismatic contact lenses, obtaining greater quality of vision free of aberrations. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

Bilateral implantation of a supplementary intraocular pinhole

PURPOSE

To evaluate the safety and efficacy of bilateral implantation of a supplementary small-aperture device to treat irregular corneal astigmatism.

SETTING

Private practice.

DESIGN

Retrospective consecutive case series.

METHODS

Patients with bilateral irregular corneal astigmatism secondary to multiple causes and consented for implantation of the XtraFocus intraocular pinhole (IOPH) were enrolled. The mean follow-up was 27 months (range 5 to 66 months). Patients were assessed in their scheduled follow-up visits and monocular and binocular uncorrected and corrected distance and near visual acuities were recorded. Assessment of darkening vision complaints was also performed after implantation in the first eye and repeated after second-eye surgery.

RESULTS

Thirty-two eyes of 16 patients were analyzed. The mean monocular and binocular uncorrected distance visual acuities improved from logMAR 1.091 ± 0.208 and 1.078 ± 0.259 preoperatively to 0.342 ± 0.091 (P < .001) and 0.342 ± 0.147 (P = .001) 1 year postoperatively. Three patients were excluded because of darkening vision complaints after surgery in the first eye. No major complications were noted after implantation of the IOPH.

CONCLUSIONS

Bilateral implantation of the XtraFocus IOPH is a safe technique in a selected group of patients. There was improvement in visual acuity sustained over the analyzed period. Postoperative darkening vision complaints vary between individuals and can limit the application of this approach in certain patients.

Implantation of the Black Artisan Iris-Claw Intraocular Lens: A Case Series

In this case series, we report the use of the black Artisan iris-claw intraocular lens (IOL) (Ophtec, The Netherlands) in 6 patients with various visually debilitating symptoms requesting occlusion of one eye. Between 2016 and 2019, 6 (5 female, 1 male) patients underwent implantation of the custom-made black Artisan iris-claw IOL after other management strategies had failed to relieve their symptoms. The black Artisan IOL is an opaque anterior chamber IOL that is fixated to the iris by enclavation. Data were obtained from the electronic patient records (Epic, Verona, WI, USA). All implantation surgeries were uneventful. In terms of outcomes, 4 patients (67%) were satisfied with the result. In 2 patients (33%), the dysphotopic symptoms were not resolved, and these patients opted for either an enucleation or an evisceration. In conclusion, a black Artisan IOL is a valuable and - if needed - reversible option in the management of patients suffering from monocular debilitating visual symptoms leading to disturbances of binocular vision. The clinical presentation leading to the implantation of a pupil-occluding IOL varies and patient satisfaction following implantation is variable. Careful preoperative evaluation of patient factors and expectations, and stepped-care management is recommended to minimize treatment failure. Pupil-occluding lens implantation is often the last step in the treatment of intractable visual complaints in eyes with complex ophthalmologic history, before evisceration or enucleation.

Don't be afraid of the dark - OCT angiography through a black intraocular lens

Purpose

To report a case in which optical coherence tomography (OCT) and OCT angiography (OCT-A) allowed imaging of the posterior pole in a patient fitted with a black occlusive intraocular lens (IOL).

Observations

Following retinal central artery occlusion, a 52-year-old patient suffered from disturbing residual light perception. Occlusive contact lenses blocked the light insufficiently, so that the patient had to rely on an eye patch for relief of symptoms. After no neovascularization had formed during an observation period of 12 months, a black IOL (Morcher 85F) was implanted, blocking wavelengths in the visible spectrum but allowing transmission in the near-infrared spectrum. Slit lamp photography, OCT and OCT-A were performed pre- and postoperatively. Postoperatively, slit lamp photography could no longer provide images of the posterior pole, proving the effective blockade of wavelengths in the visible light spectrum. In contrast, transmission in the near-infrared spectrum allowed for OCT and OCT-A imaging of the fundus. The complete suppression of the disturbing perception of light succeeded only temporarily.

Conclusions and Importance

The implantation of a black IOL does not prevent the imaging of the retinal microvasculature by OCT-A. Black IOLs can therefore be considered even if continued monitoring of the vascular situation of the posterior pole is required.

Near-infrared transmitting occlusive intraocular lens implantation for intractable diplopia: Report of two cases

OBJECTIVE

The objective of this article is to report two cases of black occlusive intraocular lens and implantation for treating intractable diplopia.

CASE DESCRIPTIONS

Two patients with intractable diplopia after orbitofacial, trauma, and surgical removal of pituitary adenoma failed to conservative management. After uneventful cataract, phacoemulsification, a black intraocular lens was implanted in every case. In both cases, a complete degree of satisfaction was achieved, with no symptoms of diplopia, and no complications have been observed in their follow-up. The use of optical coherence tomography has been possible in both cases to assess the macula and optic nerve, since a fundoscopy is not possible in such cases.

CONCLUSION

Implantation of a near-infrared transmitting occlusive intraocular lens for treating intractable diplopia provided a complete resolution of symptoms without eliminating the possibility of examining macula and optic nerve using optical coherence tomography.

Inability to perform posterior segment monitoring by scanning laser ophthalmoscopy or optical coherence tomography with some occlusive intraocular lenses in clinical use

PURPOSE

To evaluate whether occlusive intraocular lenses (IOLs) produced by several manufacturers for clinical use equivalently transmit near-infrared (IR) light for scanning laser ophthalmoscopy (SLO) or optical coherence tomography (OCT) imaging.

SETTING

Nuffield Laboratory of Ophthalmology, Oxford University, United Kingdom.

DESIGN

Evaluation of diagnostic test or technology.

METHODS

The study evaluated 6 black IOLs of 2 designs: 3 poly(methyl methacrylate) (PMMA) and 3 iris-claw anterior chamber IOLs. Each IOL was placed between a broad-spectrum white light source and a spectroradiometer to generate transmission spectra. Transmission in the near-IR range was examined using an 850 nm light-emitting diode. Scanning laser ophthalmoscopy or OCT imaging using Spectralis spectral-domain SLO or OCT was attempted through occlusive IOLs in a model eye.

RESULTS

Artisan iris-claw and MS 612 PMMA occlusive IOLs totally occluded all wavelengths of light, including in the near IR range in which SLO and OCT imaging systems operate. It was not possible to capture SLO or OCT images through the iris-claw and PMMA occlusive IOLs in a model eye.

CONCLUSIONS

Results suggest the property of near-IR transmission that permits SLO or OCT imaging through occlusive IOLs is restricted to the Morcher range of occlusive IOLs. Patients with non-near IR transmitting IOLs will not be able to receive detailed posterior segment monitoring with SLO or OCT. This finding may have a significant impact on preoperative occlusive IOL selection and the management of current patients with occlusive IOLs.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Black-on-clear piggyback technique for a black occlusive intraocular device in intractable diplopia

Black occlusive intraocular devices have been used successfully for intractable binocular diplopia. We describe a novel technique of implanting both a black occlusive device and a clear poly(methyl methacrylate) intraocular lens (IOL) in the capsular bag during phacoemulsification surgery. If the need should arise at a later date, this approach will allow safer and easier explantation of the black occlusive device, avoiding the need for IOL exchange.