Xtra focus pinhole IOL (Morchers GMBH) a novel approach to tackle irregular astigmatism and large pupillary defects with a single step surgery

Abstract

A 69-year-old patient presented to us with traumatic mydriasis with irregular pupil measuring 7 mm, with superior loss of iris tissue and large inferior peripheral iridotomy and pseudophakia. The patient had history of blunt trauma 3 years ago in a fire cracker injury. He was operated elsewhere primarily after the trauma for cataract surgery with intraocular lens implantation and had suboptimal visual outcome with glare and photophobia. He presented to us with irregular pupil and inferior iridectomy with pseudophakia. The uncorrected visual acuity was 20/150 improving to 20/50 with glasses. He had a history of cataract surgery with intraocular lens (IOL) implantation done elsewhere several years back. The patient was not a diabetic or hypertensive. There was a para central corneal scar causing irregular corneal astigmatism. Extra focus pinhole IOL was implanted in sulcus having a pinhole aperture 1.36 mm. Preoperative total corneal higher-order aberrations were 3.3 µ and total corneal coma was 0.97 µ. Postoperatively uncorrected distance visual acuity improved to 20/40 intermediate uncorrected visual acuity improved to 20/30 and uncorrected near visual acuity was J3.

Phacoemulsification, pinhole pupilloplasty, and pre-Descemet’s endothelial keratoplasty for keratoconus with Fuchs’ endothelial dystrophy

“…Agarwal et al . [ 8 ] reported the use of an Extra focus pinhole IOL, which addresses both irregular astigmatism and pupillary defects. Thus, pinhole IOL can be another alternative in such conditions; however, specialized IOL has to be procured preoperatively.…”

One-year visual outcome of secondary piggyback pinhole device implantation in pseudophakic eyes with irregular corneal astigmatism and iris trauma

“…The authors recommended the device to be used in patients with both irregular astigmatism and concurrent iris defect as they reported greatest visual improvement in these cases. Agarwal et al [ 8 ]. also reported a patient with irregular astigmatism due to a corneal scar and iris trauma resulting with glare and photophobia, benefited from the pinhole implant with complete resolution of symptoms and improved uncorrected distance, intermediate and near visual acuity.…”

“…Its secondary indications are near vision enhancement in monofocal pseudophakia and reduction of dysphotopsias in multifocal pseudophakia. Due to its black opaque diaphragm, it has also been used in patients with combined irregular astigmatism and large iris defect [ 7 , 8 ].…”

Persistently poor vision in dim illumination after implantation of XtraFocus small-aperture IOL (Morcher)

“…Small-aperture intraocular lens (IOLs) are exciting tools that address refractive error and iris loss simultaneously 4 5. The XtraFocus Pinhole IOL addresses both irregular astigmatism as well as pupillary defects.…”