This young lady developed early cataracts that necessitated cataract extraction. She was operated elsewhere, the choice of an EDOF IOL was made with the "promise" to enhance near vision, but no detailed informed consent on potential future issues in the right and that procedure was impeccable, the left was complicated by posterior capsular rupture that was managed well, with anterior vitrectomy and a 3 piece Alcon MA acrysof placed in the sulcus.
the end result was UDVA 20/20 from the OD and 20/50 from the OS due to -1.25 myopia. The problem this young lady experienced over almost 5 months postoperatively was intense night haloes, ghosting and rainbow central blurriness to the extent of a night car accident while driving. Despite the myopic refraction of the OS she preferred the quality of vision from that eye. We also noted objectively the poor visual quality on contrast sensitivity testing and HD analyzer scanning. We discussed in extent that she would either have to get used to this optical function or exchange the right IOL with a monofocal. we would explore placing a toric monofocal IOL in the bag, taken that the haptics of the IOL would be released easily after these months and incidentally in Scheimpflug tomography screening and measurement for total cornea data in IOL calculation we discovered for the first time that she also had mild keratoconus, making this measurement crucial for accuracy in our opinion. The EDOF IOL was removed and as the capsular bag had a very large capsulorrhexis and significant adhesions formed already we opted to place a 3 piece MA IOL in the sulcus. The visual result and recovery were very rewarding...
