Two Cases of Asymmetric Posterior Vaulting With an Accommodating IOL
Narrative Responses:
Purpose
To describe intraoperative asymmetric posterior vaulting (APV) of an accommodating intraocular lens (IOL) and its intraoperative management.
Methods
A retrospective analysis of the visual acuity (VA), biomicroscopy, axial length, and manifest refraction before and after cataract surgery in two patients implanted with the Crystalens accommodating lens complicated by asymmetric posterior vaulting. An IOL master was used to measure the axial lengths. Both surgeries were performed by the same surgeon using similar phacoemulsification techniques with a 5.5-6mm capsulorrhexis. In both cases, APV of the Crystalens was noted intraoperatively, and intravenous mannitol and/or a capsular tension ring were used to improve lens positioning. At the end of each case, topical antibiotic, steroid, and Atropine 1% were given.
Results
In this case series, we describe asymmetric posterior vaulting (APV) of the Crystalens model AO, an unique clinical entity that has not been previously described in the literature to our knowledge. Although the first patient did well in the immediate postoperative period, explantation of the lens and replacement with a monofocal lens due to worsening refractive error was eventually required. The second patient underwent successful lens replacement with another Crystalens with the use of a capsular tension ring and intraoperative mannitol. The patient had an uncorrected VA of 20/20 at distance and J1 at near on postoperative day one.
Conclusion
In conclusion, we described the first cases of intraoperative asymmetric capsular vaulting (APV) in association with an accommodating IOL. Additionally, we highlight the use of the capsular tension ring and intravenous mannitol to aid with the positioning of an accommodating IOL.