Surgical Approach to Decrease the Incidence of Negative Dysphotopsia after Intraocular Lens (IOL) Implantation

Purpose: To evaluate the effectiveness of two surgical approaches—differing in incision site, operating surgeon, surgical center, and optic-haptic junction orientation—on the incidence of negative dysphotopsia (ND) after cataract surgery with intraocular lens (IOL) implantation. Patients and Methods: This prospective comparative study included 102 patients who underwent cataract surgery with IOL implantation, divided into two equal groups (51 patients each). Group 1 received a supratemporal incision with a vertical optic-haptic junction. Group 2 received a superior incision with an inferotemporal optic-haptic junction. Both groups received monofocal acrylic IOLs (RayOne and Alcon AcrySof IQ). The primary endpoint was ND incidence, defined as patient-reported dark shadows or curtains in the temporal visual field, assessed on postoperative day 1 (in-person), day 3 (phone call), and week 4 (phone call) using the question: “Do you experience dark, temporal arcing shadows or curtains in your vision?” Demographic characteristics, surgical parameters, and postoperative outcomes were recorded and analysed. Results: The overall ND incidence was 2.9% (3/102 patients): 3.9% (2/51) in Group 1 and 2.0% (1/51) in Group 2, with no statistically significant difference (p = 0.558). Among patients with ND, 66.7% (2/3) had a vertical optic-haptic junction and 33.3% (1/3) had an inferotemporal junction (p = 0.558). Symptoms worsened in bright light and improved in dim lighting in 50.0% of Group 1 patients and 100% of Group 2 patients with ND. The single affected Group 2 patient reported symptom improvement by week 4; no Group 1 patients did. Conclusion: The incidence of ND was low (2.9%). No statistically significant difference was detected between the two surgical approaches. Furthermore, only three ND events were documented, statistically reliable comparisons between groups cannot be established, Also, the underlying pathophysiology of ND is likely multifactorial with different variables that extend beyond the scope of the parameters examined in the present study.