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Multifocal Intraocular Lens Explantation: A Case Series of 50 Eyes
CORRESPONDENCE Multifocal Intraocular Lens Explantation: A Case Series of 50 Eyes EDITOR: WE WENT THROUGH THE ARTICLE BY KAMIYA AND ASSOCI-
ates, which is the largest series of cases of explanted multifocal intraocular lenses (IOLs).1 The subjective and objective reasons for explantation, associated procedures, and the postoperative satisfaction have been discussed well. Overall it was an interesting article, but it does not give any new information. Instead it only confirms the information that we have in literature. On thorough study of the article, we had a few concerns as well. Some of the patients may have been missed because they underwent multifocal IOL explantation elsewhere. Patient satisfaction has been calculated based on records supplied by referring ophthalmic surgeons. This could have led to bias. It may have been more prudent to have patients with monofocal IOL explantation as the control group for satisfaction analysis. The control group characteristics, such as baseline data, preoperative and postoperative visual acuity, and contrast sensitivity, should have been mentioned. Personality and professional needs of patients could be a confounding variables in the study. Objective assessment of each symptom (glare and halos) and contrast sensitivity, will give an idea about which patient actually needs exchange. The symptoms of the patients should have been quantified, but may be limited by the retrospective nature of the study. Duration of IOL exchange ranged from 3 days to 40.5 months. The reasons for early explantation and late explantation could give us insight about which patients need early intervention. Ten patients had incorrect multifocal IOL power but only 5 underwent multifocal IOL exchange. Two eyes had underlying retinal pathology. How visual symptoms were attributed to multifocal IOL alone in these cases has not been mentioned by the authors. The authors mention that there were no complications during explant surgery or re-implant surgery. Though multifocal IOL explantation is a viable option, complications of explantation are known,2 and specific practice guidelines are not evident in this paper. Five patients had undergone yttrium-aluminum-garnet (YAG) capsulotomy prior to explantation. The details of symptoms for which YAG capsulotomy was considered, but did not help the patient, would help us analyze our patients with similar complain. It is prudent to ascertain whether posterior capsular opacity or multifocal IOL was the cause of the symptoms, and capsulotomy must be deferred until the surgeon is sure that explantation will not be required.3 202
Ó
2015 BY
Forty percent patients underwent explant surgery in another institution. This has been attributed to trust issues of the patient and nonfamiliarity of explant techniques to some surgeons.1 This could also be attributable to the surgeon’s appetite, meaning the surgeon who has implanted the IOL is less likely to advise a patient for IOL explant surgery. SIDDHARTH SHEKHAR SHRADDHA P. SUREKA SRIKANT K. SAHU
Bhubaneswar, India THE AUTHORS HAVE COMPLETED AND SUBMITTED THE ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. The authors indicate no funding support.
REFERENCES
1. Kamiya K, Hayashi K, Shimizu K, et al. Multifocal intraocular lens explantation: a case series of 50 eyes. Am J Ophthalmol 2014;158(2):215–220. e1. 2. Carlson AN, Stewart WC, Tso PC. Intraocular lens complications requiring removal or exchange. Surv Ophthalmol 1998; 42(5):417–440. 3. Woodward MA, Randleman JB, Stulting RD. Dissatisfaction after multifocal intraocular lens implantation. J Cataract Refract Surg 2009;35(6):992–997.
REPLY WE APPRECIATE THE INSIGHTFUL COMMENTS OF DR
Shekhar and associates on our published article.1 As the primary goal of this study was to assess the demographics and clinical outcomes, including the patient’s symptoms, the reasons for selecting this method, and the patient satisfaction with multifocal intraocular lens (IOL) explantation as a retrospective questionnaire survey in a large cohort of patients, it is reasonable that some of the patients may have undergone IOL explantation in another institution, and that patient satisfaction was calculated based on records supplied by referring ophthalmic surgeons. We additionally assessed the patient satisfaction in eyes undergoing monofocal IOL implantation as a control group. Although we did not routinely assess contrast sensitivity after monofocal IOL implantation, the baseline characteristics such as visual and refractive outcomes in monofocal IOL-implanted eyes were similar to those in multifocal IOL-implanted eyes. As we emphasized that it was conducted as a retrospective questionnaire survey in
ELSEVIER INC. ALL
RIGHTS RESERVED.
0002-9394/$36.00 http://dx.doi.org/10.1016/j.ajo.2014.09.032
ates, which is the largest series of cases of explanted multifocal intraocular lenses (IOLs).1 The subjective and objective reasons for explantation, associated procedures, and the postoperative satisfaction have been discussed well. Overall it was an interesting article, but it does not give any new information. Instead it only confirms the information that we have in literature. On thorough study of the article, we had a few concerns as well. Some of the patients may have been missed because they underwent multifocal IOL explantation elsewhere. Patient satisfaction has been calculated based on records supplied by referring ophthalmic surgeons. This could have led to bias. It may have been more prudent to have patients with monofocal IOL explantation as the control group for satisfaction analysis. The control group characteristics, such as baseline data, preoperative and postoperative visual acuity, and contrast sensitivity, should have been mentioned. Personality and professional needs of patients could be a confounding variables in the study. Objective assessment of each symptom (glare and halos) and contrast sensitivity, will give an idea about which patient actually needs exchange. The symptoms of the patients should have been quantified, but may be limited by the retrospective nature of the study. Duration of IOL exchange ranged from 3 days to 40.5 months. The reasons for early explantation and late explantation could give us insight about which patients need early intervention. Ten patients had incorrect multifocal IOL power but only 5 underwent multifocal IOL exchange. Two eyes had underlying retinal pathology. How visual symptoms were attributed to multifocal IOL alone in these cases has not been mentioned by the authors. The authors mention that there were no complications during explant surgery or re-implant surgery. Though multifocal IOL explantation is a viable option, complications of explantation are known,2 and specific practice guidelines are not evident in this paper. Five patients had undergone yttrium-aluminum-garnet (YAG) capsulotomy prior to explantation. The details of symptoms for which YAG capsulotomy was considered, but did not help the patient, would help us analyze our patients with similar complain. It is prudent to ascertain whether posterior capsular opacity or multifocal IOL was the cause of the symptoms, and capsulotomy must be deferred until the surgeon is sure that explantation will not be required.3 202
Ó
2015 BY
Forty percent patients underwent explant surgery in another institution. This has been attributed to trust issues of the patient and nonfamiliarity of explant techniques to some surgeons.1 This could also be attributable to the surgeon’s appetite, meaning the surgeon who has implanted the IOL is less likely to advise a patient for IOL explant surgery. SIDDHARTH SHEKHAR SHRADDHA P. SUREKA SRIKANT K. SAHU
Bhubaneswar, India THE AUTHORS HAVE COMPLETED AND SUBMITTED THE ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. The authors indicate no funding support.
REFERENCES
1. Kamiya K, Hayashi K, Shimizu K, et al. Multifocal intraocular lens explantation: a case series of 50 eyes. Am J Ophthalmol 2014;158(2):215–220. e1. 2. Carlson AN, Stewart WC, Tso PC. Intraocular lens complications requiring removal or exchange. Surv Ophthalmol 1998; 42(5):417–440. 3. Woodward MA, Randleman JB, Stulting RD. Dissatisfaction after multifocal intraocular lens implantation. J Cataract Refract Surg 2009;35(6):992–997.
REPLY WE APPRECIATE THE INSIGHTFUL COMMENTS OF DR
Shekhar and associates on our published article.1 As the primary goal of this study was to assess the demographics and clinical outcomes, including the patient’s symptoms, the reasons for selecting this method, and the patient satisfaction with multifocal intraocular lens (IOL) explantation as a retrospective questionnaire survey in a large cohort of patients, it is reasonable that some of the patients may have undergone IOL explantation in another institution, and that patient satisfaction was calculated based on records supplied by referring ophthalmic surgeons. We additionally assessed the patient satisfaction in eyes undergoing monofocal IOL implantation as a control group. Although we did not routinely assess contrast sensitivity after monofocal IOL implantation, the baseline characteristics such as visual and refractive outcomes in monofocal IOL-implanted eyes were similar to those in multifocal IOL-implanted eyes. As we emphasized that it was conducted as a retrospective questionnaire survey in
ELSEVIER INC. ALL
RIGHTS RESERVED.
0002-9394/$36.00 http://dx.doi.org/10.1016/j.ajo.2014.09.032