From Advanced Vision Care (Masket, Fram, Kwong, McLachlan); Stein Eye Institute (Masket, Fram), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA; Péterfy Sándor Street Hospital, Clinic, and Trauma Center (Rupnick), Budapest, Hungary.
J Cataract Refract Surg. 2020 Nov;46(11):1474-1479. doi: 10.1097/j.jcrs.0000000000000307.
To evaluate clinical outcomes of intraocular lens (IOL) exchange for intolerable positive dysphotopsia (PD).
Private practice, Advanced Vision Care, Los Angeles, California, USA.
Retrospective review, case series.
Fifty-six eyes of 46 pseudophakic patients requiring surgical management of PD between 2013 and 2019 were reviewed. Thirty-seven eyes had PD alone and 19 had combined negative dysphotopsia and PD.
corrected distance visual acuity of 20/30 or better without significant corneal, retinal, or optic nerve pathology.
corneal, macular, or optic nerve disease and multifocal dysphotopsia alone (defined patterns of concentric multiple halos or spider web patterns when looking at a point source of light). Primary outcome measure was improvement or resolution of self-reported PD symptoms by 3 months postoperatively. Secondary outcome measures included analysis of intraocular lenses (IOLs) that induced PD for IOL material, index of refraction, and edge design.
IOL materials successful in the alleviation of PD symptoms were as follows: 20 (87.8%) of 33 silicone, 15 (76.2%) of 21 copolymer, and 2 poly(methyl methacrylate) (100%). However, when considering IOL exchange for an acrylic to silicone optic or acrylic to collamer optic, the percentages of improvement are indistinguishable at 87% and 88%, respectively.
PD symptoms might be improved by changing the IOL material and, therefore, index of refraction. Although edge design plays an important role in etiology, changing the IOL material to a lower index of refraction may prove to be an effective surgical strategy to improve intolerable PD.
评估因无法忍受阳性光幻视（PD）而进行人工晶状体（IOL）置换的临床效果。
美国加利福尼亚州洛杉矶市高级视力护理私人诊所。
回顾性病例系列研究。
对 2013 年至 2019 年间因 PD 需手术治疗的 46 名假晶状体患者的 56 只眼进行了回顾性分析。37 只眼单纯 PD，19 只眼 PD 合并负性光幻视。
矫正远视力≥20/30，且无明显角膜、视网膜或视神经病变。
角膜、黄斑或视神经疾病以及单纯多焦光幻视（当注视点光源时出现同心多个光环或蛛网样图案）。主要观察指标为术后 3 个月时患者自我报告的 PD 症状改善或缓解情况。次要观察指标包括分析引起 PD 的 IOL 材料、折射率和边缘设计。
成功缓解 PD 症状的 IOL 材料如下：20 只（87.8%）硅酮、15 只（76.2%）共聚物和 2 只聚甲基丙烯酸甲酯（100%）。然而，当考虑将丙烯酸酯 IOL 更换为硅酮或 collamer 光学材料时，改善率分别为 87%和 88%，差异无统计学意义。
通过改变 IOL 材料和折射率可能改善 PD 症状。虽然边缘设计在病因学中起重要作用，但将 IOL 材料更换为较低折射率可能是改善无法忍受的 PD 的有效手术策略。
