Pseudophakic negative dysphotopsia: Surgical management and new theory of etiology

PurposeTo evaluate the benefit of various surgical methods to address pseudophakic negative dysphotopsia.SettingPrivate practice, Los Angeles, California, USA.DesignInterventional case series.MethodsThe following 4 surgical methods were used to treat negative dysphotopsia: secondary piggyback intraocular lens (IOL) implantation, reverse optic capture, in-the-bag IOL exchange, and iris suture fixation. Ultrasound biomicroscopy (UBM) was used to analyze posterior chamber anatomy. The primary outcome was partial or complete resolution of the negative dysphotopsia symptoms 3 months postoperatively.ResultsTwelve eyes of 11 patients with negative dysphotopsia had surgical treatment. All 10 patients who had piggyback IOL implantation or reverse optic capture had partial or complete resolution of symptoms by 3 months. No patient who had in-the-bag IOL exchange (n = 3) or iris suture fixation of the capsular bag–IOL complex (n = 1) improved despite alteration of IOL material or edge design in the case of IOL exchange or UBM confirmation of posterior chamber collapse in the case of iris suture fixation of the capsular bag–IOL complex.ConclusionsConsistent with a new hypothesis, resolution of negative dysphotopsia symptoms depended on IOL coverage of the anterior capsule edge rather than on collapse of the posterior chamber alone. Furthermore, negative dysphotopsia was not attributed to a particular IOL material or edge design.Financial DisclosureNeither author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.