Black-on-black secondary occlusive IOL implantation to alleviate enigmatic light perception through a black IOL.

UNLABELLED: A 61-year-old woman presented with an 18-year history of a debilitating ghosting phenomenon and light perception in her right eye following implantation of a Morcher black intraocular lens (IOL) for intractable diplopia. On 5 occasions, she was referred to hospital ophthalmology, repeatedly requesting right optic nerve transection to alleviate the symptoms. The mechanism of light perception across the occlusive IOL remained enigmatic, preventing appropriate management. Morcher occlusive IOLs transmit high levels of near infrared (IR) light, which may cause light perception under photopic conditions by long-wavelength cone photoreceptors. Considering this, we implanted a near IR-blocking Artisan black iris-claw IOL anterior to the Morcher occlusive IOL. Postoperatively, the light perception and ghosting disappeared and the visual quality of life score (VF-14) increased from 41 to 86. We suggest consideration of this surgical approach of black-on-black IOL implantation for patients with refractory light perception despite implantation of a near IR-transmitting occlusive IOL. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.