**8. Management of dissatisfied patients**

Even with fully preoperative examination, careful patient's selection and precisely uneventful surgery, there are always some unhappy patients with their postoperative outcomes.

The main complaints associated with presbyopia correctiong IOLs include blurred vision, photic phenomenon. Blurred vision may be present at near, intermediate, and far distances, or specific distance. It was attributed to refractive error or residual astigmatism, posterior capsule opacification, dry eye, or coexisting ocular disease. It was also caused by loss of contrast sensitivity.

The premium IOLs very affected by small residual ametropias. Surgeon must carefully calculate IOL power by using advanced biometry formulas, customize constant according to previous experience. Any astigmatism greater than 0.75 D in a blur vision patient should be treated. The most common intervention to management of residual refractive error is spectacles or contact lens. Bioptics refractive

**149**

*Successful Premium Multifocal IOL Surgery: Key Issues and Pearls*

posterior capsule makes the exchange more difficult.

exchange for a monofocal IOL is almost always an alternative [50].

Proper management of the unhappy premium IOL patient requires time, patience, and familiarity with different medical and surgical options and techniques. The most important things are extensive preoperative patient education and avoiding the inadequate patient. Careful patient selection and clear communication

Premium multifocal IOLs are a popular option for cataract or presbyopia patients today. Patients can achieve high levels of success and satisfaction from these IOLs. However, adequate preoperative clinical evaluation including patient selection, optical and anatomical examination is crucial to reach a success case. Based on the preoperative diagnosis including the corneal astigmatism, biometry measurement, IOL power calculation, presbyopia correcting IOLs' indications and contraindications should be assessment for IOL selection strategy. Surgical procedure should be technically optimized to achieve the best outcomes. Adequate management of both satisfied and unsatisfied patients will improve the benefit of

regarding realistic expectations are the keys to success with premium IOLs.

enhancement can be performed in spherical or cylinder error patients, while IOL exchange or piggyback solution also can be used in case of important defect or if the

Another common cause of blur vision after multifocal lens implantation is ocular surface disease. The symptos can be resolved by treating with lubricating artificial tears, punctal plugs, warm compress and vectored thermal pulsation

Patients with multifocal IOLs appear more sensitive to posterior capsule opacity than with monofocal IOLs. If posterior capsule opacification is suspected to be the cause of visual disturbance, and symptoms have been worsening since surgery, the surgeon should consider Nd:YAG laser capsulotomy. If there is any chance that a lens exchange may be done, YAG capsulotomy should be delayed, as an open

Photic phenomena can consist of glare, halos, and dysphotopsias. It also caused by IOL decentration, dry eye, posterior capsule opacification, or multifocal IOL design. During the procedure, carefully management should be taken including capsule tension ring implantation, centration of the IOLs relative to the visual axis, polishing the anterior and posterior capsule. Most case of photic phenomena will be tolerance or disappear by the time. After the reason of dry eye and PCO had be excluded, the night-time dysphotopsia and decreasing of contrast sensitivity are due to intrinsic properties of multifocal IOL. The most effective aid in managing these problems is neuroadaptation which is highly dependent on the individual and often need time to adapt. If a patient is still bothered by these problems more than three months after surgery, or if their quality of life is significantly affected, an IOL

*DOI: http://dx.doi.org/10.5772/intechopen.96182*

previous solutions are not possible [17].

treatments.

**9. Summary**

current premium IOLs.

#### *Successful Premium Multifocal IOL Surgery: Key Issues and Pearls DOI: http://dx.doi.org/10.5772/intechopen.96182*

enhancement can be performed in spherical or cylinder error patients, while IOL exchange or piggyback solution also can be used in case of important defect or if the previous solutions are not possible [17].

Another common cause of blur vision after multifocal lens implantation is ocular surface disease. The symptos can be resolved by treating with lubricating artificial tears, punctal plugs, warm compress and vectored thermal pulsation treatments.

Patients with multifocal IOLs appear more sensitive to posterior capsule opacity than with monofocal IOLs. If posterior capsule opacification is suspected to be the cause of visual disturbance, and symptoms have been worsening since surgery, the surgeon should consider Nd:YAG laser capsulotomy. If there is any chance that a lens exchange may be done, YAG capsulotomy should be delayed, as an open posterior capsule makes the exchange more difficult.

Photic phenomena can consist of glare, halos, and dysphotopsias. It also caused by IOL decentration, dry eye, posterior capsule opacification, or multifocal IOL design. During the procedure, carefully management should be taken including capsule tension ring implantation, centration of the IOLs relative to the visual axis, polishing the anterior and posterior capsule. Most case of photic phenomena will be tolerance or disappear by the time. After the reason of dry eye and PCO had be excluded, the night-time dysphotopsia and decreasing of contrast sensitivity are due to intrinsic properties of multifocal IOL. The most effective aid in managing these problems is neuroadaptation which is highly dependent on the individual and often need time to adapt. If a patient is still bothered by these problems more than three months after surgery, or if their quality of life is significantly affected, an IOL exchange for a monofocal IOL is almost always an alternative [50].

Proper management of the unhappy premium IOL patient requires time, patience, and familiarity with different medical and surgical options and techniques. The most important things are extensive preoperative patient education and avoiding the inadequate patient. Careful patient selection and clear communication regarding realistic expectations are the keys to success with premium IOLs.

### **9. Summary**

*Current Cataract Surgical Techniques*

tion postoperatively [68, 69] (**Figure 9**).

accident rotation after surgery [67].

postoperative outcomes.

**Figure 9.**

**8. Management of dissatisfied patients**

disease. It was also caused by loss of contrast sensitivity.

A 5.0–5.5 mm perfectly round and centered capsulorhexis is preferred for premium IOLs surgery. The right size capsulorhexis will completely cover the optic of IOLs, let the lens center over the visual axis to get the best visual results. The capsulorhexis size depends on the different IOLs design. The precise size will be customed when femtosecond laser is available, which led to less intraocular aberra-

*Trifocal IOL (Panoptix, Alcon) implantation with 5.0 mm FLACS capsulotomy.*

The Healon or other viscous ophthalmic viscoelastic device (OVD) can protect the endothelium cells during the procedure. It also can flat the anterior capsule to make capsulorhexis more controlled. The OVD should be removed completely when surgery finished to prevent intraocular pressure from increasing. If the toric multifocal IOLs used, the OVD should be totally removed behind lens to avoid the

Even with fully preoperative examination, careful patient's selection and precisely uneventful surgery, there are always some unhappy patients with their

The main complaints associated with presbyopia correctiong IOLs include blurred vision, photic phenomenon. Blurred vision may be present at near, intermediate, and far distances, or specific distance. It was attributed to refractive error or residual astigmatism, posterior capsule opacification, dry eye, or coexisting ocular

The premium IOLs very affected by small residual ametropias. Surgeon must carefully calculate IOL power by using advanced biometry formulas, customize constant according to previous experience. Any astigmatism greater than 0.75 D in a blur vision patient should be treated. The most common intervention to management of residual refractive error is spectacles or contact lens. Bioptics refractive

**148**

Premium multifocal IOLs are a popular option for cataract or presbyopia patients today. Patients can achieve high levels of success and satisfaction from these IOLs. However, adequate preoperative clinical evaluation including patient selection, optical and anatomical examination is crucial to reach a success case. Based on the preoperative diagnosis including the corneal astigmatism, biometry measurement, IOL power calculation, presbyopia correcting IOLs' indications and contraindications should be assessment for IOL selection strategy. Surgical procedure should be technically optimized to achieve the best outcomes. Adequate management of both satisfied and unsatisfied patients will improve the benefit of current premium IOLs.

*Current Cataract Surgical Techniques*
