Sir,

Black occlusive intraocular lenses (IOLs) are an effective and reversible surgical treatment for intractable diplopia unresponsive to conventional therapy.1

It has recently been established that occlusive IOLs have variable light-blocking properties in vitro, with some IOLs allowing the passage of infrared light.2, 3 The ability for posterior segment visualisation with light imaging modalities is advantageous; however, patient postoperative satisfaction can be compromised.

This case demonstrates the superior ability of black Artisan iris claw IOL to completely occlude infrared light transmitted by optical coherence topography (OCT) and resolve diplopia compared to black Morcher polymethyl methacrylate (PMMA) posterior chamber IOL in a clinical setting.

Case report

A 54-year-old man had intractable diplopia despite multiple operations to his right eye, including sub-macular translocation surgery to correct retinal folds following retinal detachment surgery. He subsequently had cataract extraction and glaucoma tube drainage surgery for secondary raised intraocular pressure.

Visual acuity was 6/36 OD and 6/4 OS, with confusion not amenable to prismatic correction. The patient did not tolerate occlusive contact lenses, and after counselling his preference was for occlusive IOL.

As he was pseudophakic, a black Morcher PMMA IOL was inserted ‘piggy back’ on his existing clear IOL in the capsular bag using a modified black on clear technique4 (Figure 1a).

Figure 1
figure 1

(a) Black Morcher IOL in situ. (b) OCT through black Morcher IOL.

Full size image

Postoperatively, his visual confusion improved but some symptoms persisted. A ‘ghost image’ was still visible, which interfered with daily activities. Posterior segment imaging with OCT demonstrated transmission of infrared light through the Morcher IOL, albeit with degraded images (Figure 1b). Subsequent implantation of an occlusive Artisan IOL resolved the patient’s symptoms and prevented further transmission of infrared light by OCT (Figures 2a and b).

Figure 2
figure 2

(a) Artisan iris claw IOL in situ. (b) OCT through black Artisan IOL.

Full size image

Comment

Artisan iris claw occlusive IOL has superior light-blocking properties compared with Morcher PMMA occlusive IOL. This has implications for patient satisfaction following surgery. Artisan IOL is associated with low complication rates5 and can be implanted to the posterior surface of the iris to give a better cosmetic appearance. Patients should however be counselled about the inability to monitor the posterior segment with light imaging modalities.