Advanced Vision Care, Los Angeles, California, and Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
Advanced Vision Care, Los Angeles, California, and Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
Ophthalmology. 2021 Nov;128(11):e195-e205. doi: 10.1016/j.ophtha.2020.08.009. Epub 2020 Aug 12.
We reviewed the literature concerning positive dysphotopsia (PD) and negative dysphotopsia (ND) regarding cause, incidence, and clinical and surgical management. In addition, we summarized our surgical experience in managing dysphotopsia. A PubMed review, limited to English language articles, yielded 149 citations; multifocal (diffractive optic) and phakic intraocular lens (IOL) dysphotopsia were excluded. Overall, 39 articles were determined to be relevant for the objectives of this investigation. Regarding PD, 7 articles corroborated that the cause of PD is related primarily to internal reflection of oblique light rays that strike the square (truncated) edge of the IOL and are reflected onto the retinal surface. No round-edged foldable IOLs are available in the United States at this time, although IOLs modified with a round anterior edge and square posterior edge show a trend toward decreased incidence of PD. High index of refraction (I/R), surface reflectivity, and IOL optic design are additional causative factors for PD. Regarding the authors' surgical experience, changing the optic material to have a lower I/R improved PD symptoms in the large majority of patients. The cause of ND seems to be multifactorial and less well understood, with some disparity between clinical and laboratory findings. Four articles that explore using ray-tracing optical modeling suggest an "illumination gap," in which some temporally incident light rays to the nasal retina pass anterior to the IOL and some are refracted posteriorly by the IOL, resulting in a gap and resultant temporal shadow. However clinically, ND is associated invariably with well-centered in-the-bag IOLs. Other implicating factors include nasal anterior capsule override, haptic orientation, large-angle κ value, and high hyperopia. Persistent ND has been treated successfully or reduced with reverse (anterior) optic capture, sulcus IOL placement, piggyback IOLs, and neodymium:yttrium-aluminum-garnet nasal capsulectomy. Two articles reference a new optic edge designed to capture the anterior capsulotomy, mimicking reverse optic capture. Persistent dysphotopsia after cataract surgery is a significant cause for patient dissatisfaction. The cause and management of both ND and PD are of significance, and new IOL designs and alternative surgical strategies may help to mitigate these unintended side effects of IOL implantation.
我们回顾了有关正性像差性（PD）和负性像差性（ND）的文献，包括其病因、发生率以及临床和手术治疗。此外，我们还总结了我们在处理像差方面的手术经验。通过对 PubMed 的英文文献回顾，共获得了 149 篇参考文献；排除了多焦点（衍射光学）和有晶状体眼人工晶状体（IOL）像差。总的来说，有 39 篇文章与本研究的目的相关。关于 PD，有 7 篇文章证实 PD 的病因主要与斜光线的内部反射有关，这些光线撞击 IOL 的方形（截断）边缘，并反射到视网膜表面。目前在美国还没有使用圆形边缘的折叠式 IOL，尽管具有圆形前边缘和方形后边缘的 IOL 显示出降低 PD 发生率的趋势。高折射率（I/R）、表面反射率和 IOL 光学设计是 PD 的其他致病因素。关于作者的手术经验，改变光学材料的 I/R 可以改善大多数患者的 PD 症状。ND 的病因似乎是多因素的，并且了解较少，临床和实验室发现之间存在一些差异。有 4 篇探讨使用光线追踪光学建模的文章表明存在“照明间隙”，其中一些向鼻侧视网膜的暂时入射光线在 IOL 之前向前通过，一些被 IOL 向后折射，从而产生间隙和相应的颞侧阴影。然而，临床上，ND 总是与中心位置良好的袋内 IOL 相关。其他涉及的因素包括鼻侧前囊覆盖、襻的方向、大角度 κ 值和高度远视。通过反向（前）光学捕获、巩膜 IOL 放置、叠加 IOL 和钕：钇-铝-石榴石鼻囊切除术成功或减轻了持续性 ND 的治疗。有 2 篇文章提到了一种新的光学边缘设计，旨在捕获前囊切开术，模拟反向光学捕获。白内障手术后持续性像差是导致患者不满的一个重要原因。ND 和 PD 的病因和治疗都很重要，新的 IOL 设计和替代手术策略可能有助于减轻 IOL 植入的这些意外副作用。
