Z deformity of an acommodative IOL Dr.Ashwin Shetty , Dr.Mathew K. Cataract and Refractive Lens Surgery Services Narayana Nethralaya,Bangalore ,India No Financial Disclosure

Purpose To describe a post operative complication of an accommodating Intraocular Lens (IOL).

Materials and Methods Phacoemulsification was performed using a standard technique through a 3.2mm superior clear corneal incision with in-the-bag placement of the Crystalens HD accommodating IOL. Uneventful intra- operative and immediate post operative course

4th post-op week UCVA - 6/24, N6. BSCVA - 6/6,N6 Acceptance -0.5D sph/ -0.75Dcylx95 ,near add +0.75D

4th post-op week The Capsulorhexis showed ovalization along the long axis of the IOL . Forward bowing of the superior haptic with backward bowing of the inferior haptic. PC folds along the long axis of the IOL.

4 weeks post op Anterior vaulting of superior Haptic Part of CCC behind IOL Posterior vault of inferior haptic Ovalization of capsulorhexis margin

IOL repositioning was attempted the next day. Z deformity persisted even after IOL repositioning.

BSCVA 6/6 ,N6 with -1.0Dsph /-0.75D Cylx75˚ ,Near Add +0.75D 8 weeks post op UCVA 6/30,N6 BSCVA 6/6 ,N6 with -1.0Dsph /-0.75D Cylx75˚ ,Near Add +0.75D

Discussion IOL tilt can produce unwanted refractive errors and significant post operative astigmatism. The Z – deformity is peculiar to the Crystalens accommodating IOL which is a hinged silicone plate haptic IOL. The cause is capsular contraction.

Tilting of the IOL optic Z - deformity Capsular Contraction Compression of the haptics Anterior Bowing of one of the haptics, posterior bowing of the other Tilting of the IOL optic Z - deformity

Conclusion Even with multiple modifications to IOL design to prevent Z deformity,it can still happen with the Crystalens HD thereby adversely affecting refractive outcomes.