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CASE REPORT
Synchrony® pseudo-accomodating intraocular lens
luxated into the vitreous cavity after injury
Adriana Fandiño-López, MD1; Ester Fernández-López, MD1; Mikhail Hernández- Díaz, MD1;
Francisco Pastor-Pascual, MD, PhD1; Cristina Peris-Martínez, MD, PhD1
ABSTRACT: The Synchrony® IOL is a single-piece, dual-optic, pseudo-accommodating
lens. We present a clinical case of vitreous luxation of this lens two years after cataract surgery
(phacoemulsification) without complications. A 23-gauge pars plana vitrectomy procedure
was performed, the lens was elevated with perfluorocarbon liquid and luxated to anterior
chamber. Given the large size of the lens, the haptics joining the two optics were cut in the
anterior chamber, allowing the lens to be extracted with ease through a limbal incision.
Finally, a three-piece lens was placed in the sulcus, with good postoperative outcome.
J Emmetropia 2015; 6: 27-29
Accommodation is a physiological process in which
the eye changes its refractive power to focus on objects located at different distances from the retina.
The loss of accommodation, or presbyopia, is the
most common visual dysfunction, affecting most of
the population over 40 years of age1,2. Presbyopia is
considered an important problem because it leads to
complete loss of a physiological function roughly two
thirds through an individual’s lifetime. Few physiological functions suffer such a significant and systematic deterioration at such an early age and on such a
generalized basis3.
Postoperative capsular fibrosis and capsular
contraction after conventional cataract surgery anchor
the IOL firmly in the capsule. Since the elasticity
of conventional intraocular lenses (IOLs) is poor,
they do not change their shape or curvature during
contraction of the ciliary muscle, so accommodation
is impaired in patients undergoing cataract surgery4.
Submitted: 08/17/2014
Revised: 3/11/2015
Accepted: 3/26/2015
FISABIO-Oftalmología Médica
1
Financial disclosure: The authors have no commercial or proprietary
interest in the products mentioned herein.
Corresponding Author: Adriana Fandiño-López
FISABIO-Oftalmología Médica
Bifurcación Pío Baroja-General Avilés, S/N, 46015 Valencia, Spain
E-mail: [email protected]
© 2015 SECOIR
Sociedad Española de Cirugía Ocular Implanto-Refractiva
Attempts have been made to compensate for loss of
accommodation with diffractive and refractive bifocal
lenses as well as with trifocal lenses, with variable
results5,6. IOLs, called pseudo-accommodating IOLs,
have recently been designed with flexible haptics that
allow them to move within the eye and thus preserve
accommodative power after cataract surgery7. Pseudoaccommodating lenses are based on the anterior axial
movement of the IOL optic in response to contraction
of the ciliary muscle8. Different models of pseudoaccommodating IOLs based on this axial optic
movement have appeared on the market. Ultrasound
biomicroscopy has shown that single-optic lenses move
less than 1 mm forward during accommodative effort.
In addition, single-optic pseudo-accommodating
lenses with less refractive power will generate less
“accommodation” with anteroflexion than IOLs with
greater power8. Other models were thus designed
that attempted to better mimic the accommodation
movement of a young natural crystalline lens.
The Synchrony® pseudo-accommodating IOL
(Abbott Medical Optics) is an innovative singlepiece, dual-optic, foldable silicone lens. It has a
5.5 mm anterior optic with positive dioptric power
(+32 D) which is connected via haptics to a 6.0 mm
posterior optic with negative power. The haptics have
a spring-like movement that attempts to mimic the
accommodative movement of the crystalline lens
when placed within the capsular bag9,10. We present
a case of luxation into the vitreous cavity of this lens,
which we consider to be of interest because a search
of the literature has revealed it to be the first report of
such a case.
ISSN: 2171-4703
27
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LUXATION OF SYNCHRONY PSEUDO-ACCOMODATING IOL
CASE REPORT
A 72-year-old woman, with no history of interest,
operated for cataracts in both eyes (BE) two years
ago by phacoemulsification and implantation in the
capsular bag of a Synchrony® pseudo-accomodating
intraocular lens (dual-optic). Surgeries were
performed without complications. She was seen in
the emergency clinic of our department for sudden
loss of vision in the right eye (RE) following ocular
trauma after falling out of bed. Best corrected visual
acuity (BCVA) was 0.62 (with addition of +12.5 D)
in the RE and 1 (+0.5, −1 × 15°) in her left eye (LE).
Examination of the anterior pole of the RE
revealed rupture of the posterior capsule with
aphakia. In addition, on examination of the posterior
pole, the Synchrony® intraocular lens was observed
to be luxated into the vitreous cavity with the retina
attached, and with no evidence of retinal breaks
(Figures 1 and 2).
A 23G pars plana vitrectomy was performed and
perfluorocarbon liquid was injected into the vitreous
cavity allowing the lens to float on the surface of
the perfluorocarbon and bringing the IOL behind
the iris, where it was easily luxated to the anterior
chamber using a forceps. Following this, and given
the size of the lens, the haptics joining the two
optics were cut with Vannas scissors separating the
two optics, to facilitate the extraction of the lens.
Both halves were extracted through a 5 mm limbal
incision and anterior vitrectomy was performed.
Finally, given that the anterior capsulorhexis was
intact and there was good support, a three-piece
lens was implanted in the sulcus followed by corneal
sutures.
Twelve days after surgery, the patient had a BCVA
of 0.8, the IOL in the sulcus was normally positioned
and the rest of the examination was normal. At one
year, BCVA was 0.9 (+0.75 −0.75 × 145°) (Figures 3
and 4). In the LE, pseudophakia was correct.
Figure 3. Twelve days after surgery, the patient had a BCVA
of 0.8, the IOL in the sulcus was normally positioned and the
rest of the examination was normal. (Pupil under drug-induced
mydriasis)
Figure 1. Examination of the posterior pole of RE after luxation.
Funduscopic image showing Synchrony® intraocular lens luxated into
the vitreous cavity with the retina applied without evidence of retinal
breaks.
Figure 2. Image of RE obtained by posterior optical coherence
tomography (OCT, Topcon, Oakland, USA) revealing normal foveal
profile after the luxation.
Figure 4. Anterior pole at 1 year after surgery. BCVA was 0.9 in
this eye.
JOURNAL OF EMMETROPIA - VOL 6, JANUARY-MARCH
LUXATION OF SYNCHRONY PSEUDO-ACCOMODATING IOL
DISCUSSION
3.
Despite excellent results in restoring vision following
cataract surgery and IOL implantation, lack of
accommodation after surgery still needs to be
addressed11. Pseudo-accommodating IOLs can help
restore accommodation since they transform the
contractile force of the ciliary muscle into an anterior
movement of the optic along the visual axis, which in
turn changes the refractive power of the eye8.
Despite the tremendous advances made in cataract
surgery over the years, IOL luxation into the vitreous
cavity is a complication that is estimated to occur in
0.2%-3% of cases12. Luxation can be either spontaneous
or traumatic, and it can occur after both complicated
and uncomplicated cataract surgery (as in our case).
Numerous techniques for extracting a luxated IOL
are described in the literature, but only in the case of
a single optic13. The luxated Synchrony® IOL described
in this case has a dual optic which would a priori seem
enormously difficult to extract.
The Synchrony® lens is a safe pseudo-accommodating
intraocular lens14 with a rate of complications similar to
that of single optic lenses15. It can also be implanted
without distortion or ovalization of the capsulorhexis
and capsular bag16, and has all the advantages of a dual
but monofocal optic (greater contrast sensitivity and
absence of halos)15.
This IOL was initially inserted with forceps because
of the difficulty involved in folding it10. An innovative
injector was subsequently developed in which the lens
is preloaded and ready for implantation through a
primary incision of approximately 3.5 mm, without the
need for suture, as in the case described here. This gives
an idea of the enormous flexibility of the lens. The same
characteristics that allow for easy insertion through a
relatively small incision size for the dimensions of the
lens14 also facilitate extraction.
Despite the apparently large size of the lens, it is very
flexible and easy to handle. In this case, it was no more
difficult to extract than a single optic lens.
4.
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Peris-Martínez C, Díez-Ajenjo A, García-Domene C. Shortterm results with the Synchrony lens implant for correction of
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application. 9th Ed. St. Louis: Mosby Year Book; 1992.
Pastor FP. Restauración de la acomodación tras la cirugía de
cataratas: lentes intraoculares acomodativas. Universitat de
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JOURNAL OF EMMETROPIA - VOL 6, JANUARY-MARCH
First author:
Adriana Fandiño-López, MD
Fundación Oftalmológica del Mediterráneo. Valencia, Spain