1. 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

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

3. 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

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

5. 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.

6. 4 weeks post op Anterior vaulting of superior Haptic
Part of CCC behind IOL
Posterior vault of inferior haptic
Ovalization of capsulorhexis margin

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

8. 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

9. 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.

10. 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

11. 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.