Trifocal versus monofocal intraocular lens implantation in eyes previously treated with laser in situ keratomileusis (LASIK) for myopia.

PURPOSE: To assess visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes that had previously undergone laser in situ keratomileusis (LASIK) for myopia and to compare them with those recorded after implantation of a monofocal IOL. DESIGN: Retrospective comparative cases series. METHODS: This study evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), safety, and efficacy after the implantation of two comparable trifocal IOL models and one monofocal IOL model in patients who had previously undergone myopic LASIK. Patients were classified according to the implanted IOL (monofocal or trifocal). RESULTS: A total of 211 eyes from 170 patients received a monofocal IOL, and 211 eyes from 161 patients received a trifocal IOL. At the end of the study, after lensectomy, there was a higher myopic residual spherical equivalent in the monofocal group because some eyes had been targeted for slight myopia to achieve monovision; therefore, UDVA was better in the trifocal group. CDVA was comparable in both groups. As expected, both monocular and binocular UNVA were significantly better in the trifocal group. Although the percentage of eyes that lost ≥1 line of CDVA did not differ between the groups, the safety index was slightly better in the monofocal group. CONCLUSION: Although implantation of monofocal and trifocal IOLs after myopic LASIK yielded excellent distance visual outcomes, UNVA was significantly better for the trifocal IOL, with a minimally worse safety profile. Trifocal IOLs can be considered after previous LASIK for myopia, with an appropriate patient selection.

Comparison of Patients With Emmetropia and Presbyopia and Different Accommodation Who Undergo Unilateral or Bilateral Implantation of a Trifocal IOL.

PURPOSE: To compare visual outcomes and satisfaction in patients with emmetropia, presbyopia, and greater or lesser residual accommodation who undergo unilateral or bilateral implantation of a trifocal diffractive intraocular lens (IOL). METHODS: A multicenter, multisurgeon study was performed to evaluate outcomes in patients with emmetropia and presbyopia who underwent refractive lens exchange followed by implantation of a FineVision trifocal IOL (PhysIOL). The inclusion criteria were as follows: emmetropia, sphere -0.25 to +0.50 diopters (D), cylinder less than 0.75 D, and manifest refractive spherical equivalent (MRSE) of -0.25 to +0.25 D. All patients also had to have an uncorrected distance visual acuity (UDVA) of Snellen 0.9 or better in each eye. The sample was divided into different clusters based on two variables: eyes operated on (monocular or binocular) and age either younger than 55 years or 55 years or older. Thus, four possible groups were created. Visual and refractive performance, patient satisfaction, and spectacle independence were assessed. RESULTS: A total of 690 eyes from 431 patients were evaluated. There was no difference in postoperative uncorrected (UDVA) and corrected (CDVA) distance visual acuity between the groups. Binocular uncorrected near vision (UNVA) was better in patients who underwent surgery on both eyes regardless of age (median [interquartile range]: 0.00 [0.00; 0.10] vs 0.10 [0.00; 0.10] logMAR; P < .001). Binocular uncorrected intermediate vision (UIVA) was better in patients who underwent surgery on both eyes aged younger than 55 years than in those who underwent surgery in one eye aged 55 years or older (median [interquartile range]: 0.18 [0.10; 0.18] vs 0.30 [0.18; 0.30] logMAR; P < .001). The efficacy and safety indexes were 0.98 ± 0.09 and 1.01 ± 0.06, respectively. A total of 93.3% of eyes were within the 0.50 D range in postoperative MRSE. Visual dysphotopsia was worse in patients with both eyes operated on, although the differences were not statistically significant. CONCLUSIONS: The study shows that after refractive lens exchange, patients with emmetropia and presbyopia who received a trifocal IOL in one or both eyes achieved good UNVA, UIVA, and UDVA. Regarding near binocular visual acuity, results were better for patients who underwent surgery on both eyes than for those who underwent surgery on one eye. Regarding binocular intermediate visual acuity, patients aged younger than 55 years with both lenses replaced had better results than those 55 years or older with only one lens replaced. However, no significant differences were observed in UDVA or patient satisfaction. [J Refract Surg. 2023;39(12):817-824.].

Visual and refractive outcomes after implantation of two models of trifocal intraocular lenses in eyes with previous corneal ablation to treat hyperopia.

BACKGROUND: To assess whether a trifocal intraocular lens (IOL) with neutral spherical aberration (SA) provides better visual and refractive outcomes than a trifocal IOL with negative SA after hyperopic corneal laser ablation. METHODS: This is a retrospective comparative study. Patients were classified according to the IOL implanted after cataract or clear lens phacoemulsification [group 1, PhysIOL FineVision Pod-F (negative SA); group 2, Rayner RayOne Trifocal (neutral SA)]. We evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), predictability, safety, efficacy, and satisfaction. RESULTS: 198 eyes of 119 patients met the inclusion criteria. Group 1 comprised 120 eyes and group 2 comprised 78 eyes. At completion, the refractive and predictability results were significantly better in group 1 than in group 2 for manifest refraction spherical equivalent (MRSE) (P < 0.001). Differences were not significant for UDVA (P = 0.647), CDVA (P = 0.343), UIVA (P = 0.059), UNVA (P = 0.382), binocular UIVA (P = 0.157), or binocular UNVA (P = 0.527). Safety and efficacy indices in refractive lens exchange (RLE) eyes were 0.96 and 0.91, and 0.89 and 0.93 in groups 1 and 2, respectively (P = 0.254 and 0.168). Patient satisfaction was similar in both groups (P > 0.05, all items). CONCLUSION: In eyes previously treated with hyperopic corneal ablation, implantation of a trifocal IOL with neutral SA provided better efficacy and safety outcomes but worse predictability outcomes than those obtained with a trifocal model with negative SA.

Laser corneal enhancement after trifocal intraocular lens implantation in eyes that previously had photoablative corneal refractive surgery.

PURPOSE: To evaluate the visual and refractive outcomes of laser corneal enhancement after trifocal intraocular lens (IOL) implantation in eyes previously treated with myopic/hyperopic laser corneal refractive surgery (LCRS). SETTING: Clinica Baviera-AIER-Eye Group, Spain. DESIGN: Retrospective comparative case series. METHODS: Patients were divided by primary LCRS into myopic and hyperopic groups. The outcomes evaluated were uncorrected distance (UDVA), corrected distance (CDVA), uncorrected intermediate (UIVA), and uncorrected near visual acuity (UNVA), and predictability, safety, efficacy, and satisfaction after implantation of 2 trifocal IOL models (Physiol-FineVision and Zeiss-ATLisa 839) and subsequent laser enhancement. RESULTS: 186 eyes (89 myopic and 97 hyperopic eyes) from 146 patients were assessed. At the last visit, refractive outcomes were better in myopic than those in hyperopic eyes, with statistically significant differences for sphere ( P < .001), cylinder ( P < .001), manifest refraction spherical equivalent (MRSE) ( P = .003), CDVA ( P = .005), UDVA ( P = .047), and UNVA ( P = .003) but not for UIVA ( P = .580), binocular UIVA ( P = .660), or binocular UNVA ( P = .836). Predictability differences were nonsignificant between groups for a final MRSE of ±0.5 diopters (D) and ±1.0 D (P = .167 and .502, respectively). Efficacy and safety were similar in both groups ( P = .235 and P = .080). A greater myopic MRSE was present after trifocal implantation in myopic than in hyperopic eyes (MRSE = -0.93 vs -0.69 D, P = .013), and the statistically significant differences were maintained after enhancement between both groups (MRSE -0.00 vs 0.00 D, P = .003). Overall satisfaction was similar in both groups ( P > .05 all items). CONCLUSIONS: Corneal laser enhancement after implantation of a trifocal IOL in eyes previously treated for myopia or hyperopia with LCRS was safe, effective, predictable, and highly satisfactory.

Visual Outcomes Following Bilateral lmplantation of Two Diffractive Trifocal Intraocular Lenses in 10 084 Eyes.

PURPOSE: To investigate refractive and visual acuity outcomes, patient satisfaction, and spectacle independence at 3 months of 2 diffractive (non-toric) trifocal intraocular lenses (IOLs) in a large series of patients. DESIGN: Multicenter, retrospective, nonrandomized clinical study. METHODS: Patients underwent lens phacoemulsification and were implanted bilaterally with a diffractive trifocal IOL: FineVision Micro F (PhysIOL SA, Liège, Belgium) or AT Lisa tri 839MP (Carl Zeiss AG, Jena, Germany). Surgeries were performed between 2011 and 2015 with at least 3 months of follow-up. Visual and refractive performance, patient satisfaction, and spectacle independence were evaluated. RESULTS: A total of 10 084 trifocal IOLs were bilaterally implanted (5802 FineVision in 2901 patients and 4282 AT Lisa in 2141 patients). Three-month mean (± standard deviation) acuity: AT Lisa, binocular uncorrected distance visual acuity (UDVA), -0.01 logMAR ± 0.06; monocular distance corrected visual acuity (CDVA), 0.02 logMAR ± 0.06; binocular uncorrected near visual acuity (UNVA) at 40 cm, 0.05 logMAR ± 0.08; binocular uncorrected intermediate visual acuity (UIVA) at 80 cm, -0.05 logMAR ± 0.14; postoperative spherical equivalent, 0.26 D ± 0.47; cylinder -0.34 D ± 0.38; FineVision Micro F, binocular UDVA, 0.01 logMAR ± 0.05; monocular CDVA, 0.03 logMAR ± 0.06; binocular UNVA, 0.05 logMAR ± 0.08; binocular UIVA, -0.05 logMAR ± 0.12; spherical equivalent, 0.34 D ± 0.50; cylinder -0.39 D ± 0.40. The IOLs were equivalent in achieving spectacle independence; 98% were "satisfied" to "very satisfied" with their IOL performance. CONCLUSIONS: In this retrospective study with over 5000 patients, implantation of both trifocal IOL models provided good functional distance, intermediate, and near visual acuity, resulting in high levels of both spectacle independence and patient satisfaction.