This patient received a light-adjustable lens (LAL from RxSight) and was not happy with the outcome due to both negative and positive dysphotopsias. Our guest surgeon is tasked with performing an IOL exchange however when visco-dissection is performed the posterior capsule rips open. Now the case is far more challenging particularly with the fibrosis seen in the picture here around the optic edge and encasing the haptics. With this being a +28.0 D IOL, that means that the incidence of negative dysphopsias (the enigmatic penumbra as explained by Dr Jack Holladay in the podcast that is coming up later this week) is significantly higher. The new IOL is placed in the reverse optic capture position so that the gap between the iris and optic is lessened to address the negative dysphotopsias). Really a great learning case.
