Visual aberrations in a multifocal intraocular lens with injection-related scratches

We describe the case of a 70-year-old woman who had phacoemulsification and implantation of a single-piece hydrophobic acrylic multifocal intraocular lens (IOL). Following surgery, the patient experienced blurring, positive dysphotopsia, impaired night vision, and glare. After 2 years, optic damage likely related to the IOL injection procedure was noted. The IOL was successfully exchanged. The uncorrected distance visual acuity was 20/20, and the patient reported no further visual aberrations. Gross and microscopic examination revealed large linear scratches on the central part of the optic. Scheimpflug photography with densitometry analysis of the area of the anterior scratches revealed extremely high levels of surface backlight scattering (227 computer-compatible tape units). Modulation transfer function and Badal images of the explanted IOL and of a control IOL did not differ significantly. This report suggests that severe defects/damage such as those described would likely be clinically significant in IOLs with specialized optics and warrant immediate removal/exchange of a damaged multifocal IOL. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.