Multifocal intraocular lenses in cataract surgery: literature review of benefits and side effects.

UNLABELLED: This literature review looks at the current status of multifocal intraocular lenses (IOLs) in cataract surgery. The results of implantation of multifocal IOLs of diffractive, refractive, and hybrid diffractive-refractive design are described with regard to uncorrected near and distance visual acuity and spectacle independence. The occurrence of photic phenomena and contrast sensitivity loss with multifocal IOLs are also addressed. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.

Visual outcomes and patient satisfaction after cataract surgery with toric multifocal intraocular lens implantation.

PURPOSE: To evaluate visual outcomes and patient satisfaction after toric multifocal intraocular lens (IOL) implantation in patients with cataract and corneal astigmatism. SETTING: University Eye Clinic Maastricht, The Netherlands. DESIGN: Cohort study. METHODS: Patients with cataract, corneal astigmatism, and a motivation for spectacle independency had cataract surgery with implantation of a toric diffractive multifocal IOL (AT Lisa). Three months postoperatively, the uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuities; corrected distance, intermediate, and near visual acuities; residual refractive astigmatism; defocus curve; contrast sensitivity; and patient satisfaction were evaluated. RESULTS: Forty-five eyes of 25 patients were enrolled. Postoperatively, the mean UDVA was 0.04 logMAR ± 0.15 (SD) and 98% of eyes achieved a UDVA of 20/40 or better. The mean UNVA was 0.20 ± 0.16 logMAR and the mean UIVA (at 60 cm), 0.40 ± 0.16 logMAR. Residual refractive astigmatism of -1.00 diopter or less was achieved in approximately 90% of eyes. Contrast sensitivity levels were high. Approximately 50% of patients reported moderate glare, halos, and starburst symptoms. Spectacle independency for distance and near vision was achieved by 95% of patients and 79% of patients, respectively. CONCLUSIONS: Toric IOL implantation in patients with cataract and corneal astigmatism provided good distance and near visual outcomes and acceptable intermediate visual outcomes, allowing patients with considerable amounts of corneal astigmatism to achieve spectacle independence at distance and near. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Dissatisfaction after implantation of multifocal intraocular lenses.

PURPOSE: To analyze the symptoms, etiology, and treatment of patient dissatisfaction after multifocal intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, Maastricht University Medical Center, The Netherlands. DESIGN: Case series. METHODS: In this retrospective chart review, the main outcome measures were type of complaints, uncorrected and corrected distance visual acuities, uncorrected and distance-corrected near visual acuities, refractive state, pupil diameter and wavefront aberrometry measurements, and type of treatment. RESULTS: Seventy-six eyes of 49 patients were included. Blurred vision (with or without photic phenomenon) was reported in 72 eyes (94.7%) and photic phenomena (with or without blurred vision) in 29 eyes (38.2%). Both symptoms were present in 25 eyes (32.9%). Residual ametropia and astigmatism, posterior capsule opacification, and a large pupil were the 3 most significant etiologies. Sixty-four eyes (84.2%) were amenable to therapy, with refractive surgery, spectacles, and laser capsulotomy the most frequent treatment modalities. Intraocular lens exchange was performed in 3 cases (4.0%). CONCLUSION: The cause of dissatisfaction after implantation of a multifocal IOL can be identified and effective treatment measures taken in most cases.

Visual outcomes after cataract surgery with implantation of a +3.00 D or +4.00 D aspheric diffractive multifocal intraocular lens: Comparative study.

PURPOSE: To compare the visual performance after cataract surgery with implantation of +3.00 diopter (D) or +4.00 D aspheric multifocal intraocular lenses (IOLs). SETTING: Department of Ophthalmology, Maastricht University Medical Center, The Netherlands. METHODS: This prospective study compared the results of bilateral cataract surgery with implantation of a +3.00 D AcrySof ReSTOR SN6AD1 IOL or a +4.00 D AcrySof ReSTOR SN6AD3 IOL. The main outcome measures were binocular uncorrected (UDVA) and corrected distance visual acuities, binocular uncorrected (UNVA) and corrected near visual acuities, binocular uncorrected (UIVA) and corrected intermediate visual acuities, preferred working distance, straylight and contrast sensitivity levels, and wavefront aberrometry measurements. RESULTS: The +3.00 D IOL was implanted in 68 eyes and the +4.00 D IOL, in 46 eyes. The UIVA was significantly better in the +3.00 D IOL group than in the +4.00 D IOL group at 40, 50, 60, and 70 cm. The preferred working distance for near tasks was significantly lower in the +3.00 D IOL group (38.9 cm) than in the +4.00 D IOL group (31.0 cm). The UDVA was better in the +3.00 D IOL group; the UNVA at the preferred working distance was similar in the 2 groups. Contrast sensitivity and intraocular straylight levels were also similar. The mean levels of higher-order and spherical aberrations were lower in the +3.00 D IOL group. CONCLUSION: Cataract surgery with the +3.00 D IOL resulted in better intermediate vision than with the +4.00 D model without compromising distance and near visual acuity. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Case of late-onset corneal decompensation after iris-fixated phakic intraocular lens implantation.

A 48-year-old myopic patient with bilateral anterior chamber depth of 3.1 mm and endothelial cell density (ECD) of 2525 cells/mm(2) and 2638 cells/mm(2) preoperatively had bilateral implantation of an Artisan iris-fixated phakic intraocular lens (pIOL). Five years postoperatively, unilateral corneal stromal edema was seen in a circumscribed area overlying the temporal ridge of the pIOL in the right eye; the ECD was 1631 cells/mm(2) and the pachymetry, 586 microm. Explantation of the pIOL was refused by the patient. Seven years postoperatively, the ECD was 413 cells/mm(2) in the right eye and corneal decompensation occurred. The progressive unilateral endothelial loss was explained by excessive rubbing of the eyes because of chronic itching and an anterior shift of the pIOL over the 7 years as demonstrated by anterior optical coherence tomography.

Results of cataract surgery after implantation of an iris-fixated phakic intraocular lens.

PURPOSE: To report the results of cataract surgery after previous implantation of an Artisan iris-fixated phakic intraocular lens (pIOL) for the correction of myopia. SETTING: University center and private practice. METHODS: This study comprised eyes with previous implantation of an iris-fixated pIOL to correct myopia and subsequent pIOL explantation combined with cataract surgery and in-the-bag implantation of a posterior chamber IOL. Predictability of refractive results, changes in endothelial cell density (ECD), and postoperative best corrected visual acuity (BCVA) were analyzed. RESULTS: The mean follow-up after cataract surgery in the 36 eyes of 27 consecutive patients was 5.7 months +/- 7.5 (SD). The mean time between pIOL implantation and cataract surgery was 5.0 +/- 3.4 years. After explantation of the pIOL and subsequent cataract surgery, the mean spherical equivalent (SE) was -0.28 +/- 1.11 diopters (D); the SE was within +/-1.00 D of the intended correction in 72.2% of patients and within +/-2.00 D in 86.1% of patients. The mean endothelial cell loss after the combined procedure was 3.5% +/- 13.2% and the mean postoperative BCVA, 0.17 +/- 0.18 logMAR. CONCLUSIONS: In patients with a history of implantation of an iris-claw pIOL for the correction of myopia, cataract surgery combined with explantation of the pIOL yielded acceptable predictability of the postoperative SE and minimal loss of ECD, resulting in a gain in BCVA.

Irregular astigmatism after cataract surgery resulting from inadequate clear corneal incision formation.

A 66-year-old woman was referred to us due to visual complaints after cataract surgery. The patient's complaints were decreased visual acuity and a localized blur in her visual field. At slit lamp biomicroscopy, an unusually long and centrally located clear corneal incision was noted. Corneal topography revealed an irregular astigmatism in the optical axis, originating from the site of the incision. The patient's visual complaints were treated by fitting a rigid gas permeable contact lens, which increased her best corrected visual acuity to 20/16. This case report demonstrated that inadvertently long and centrally located corneal incisions should be avoided during cataract surgery to prevent high levels of irregular astigmatism. RGP contact lenses can lead to successful visual rehabilitation.

Long-term follow-up of a multifocal apodized diffractive intraocular lens after cataract surgery.

PURPOSE: To report the long-term performance of the AcrySof ReSTOR SA60D3 intraocular lens (IOL) after cataract surgery. SETTING: University Hospital Maastricht, Maastricht, The Netherlands. METHODS: This prospective clinical trial comprised 44 eyes (22 consecutive patients) having cataract surgery with implantation of the ReSTOR IOL. Monocular and binocular uncorrected distance visual acuity, best corrected distance visual acuity, uncorrected near visual acuity, best distance-corrected near visual acuity, spectacle dependence, undesired visual symptoms, patient satisfaction, and incidence of posterior capsule opacification were analyzed 6 months and 3 years postoperatively. RESULTS: The mean uncorrected distance acuity (logMAR) was 0.046 +/- 0.099 at 6 months and 0.115 +/- 0.173 at 3 years and the mean best corrected distance acuity, -0.040 +/- 0.075 and -0.018 +/- 0.093, respectively. Binocular uncorrected and best-corrected near acuities (logMAR) were 0.009 +/- 0.029 at 6 months and 0.014 +/- 0.035 at 3 years. All patients achieved a binocular uncorrected and best distance-corrected near acuity of 20/25 or better at 6 months and 3 years. On a quality-of-life questionnaire, patients reported good distance, intermediate, and near acuity without complaints of severe glare or halos. Complete spectacle independence for distance and near acuity was achieved by 83.7% and 81.9% of patients, respectively, at 6 months and 85.0% and 75.0% of patients, respectively, at 3 years. Four eyes (9.1%) required neodymium:YAG capsulotomy. CONCLUSIONS: Cataract surgery with the AcrySof ReSTOR SA60D3 IOL provided good, stable distance and near visual acuities over a 3-year follow-up, leading to low spectacle independence and high patient satisfaction.

Astigmatism management in cataract surgery with the AcrySof toric intraocular lens.

PURPOSE: To present clinical data from a single-center prospective clinical trial of the AcrySof toric intraocular lens (IOL). SETTING: Academic Hospital Maastricht, Maastricht, The Netherlands. METHODS: Fifty-three eyes (43 patients) had implantation of an AcrySof toric IOL. Three toric models were evaluated in cylinder powers of 1.50 diopters (D) (SN60T3; T3 group, n = 16), 2.25 D (SN60T4; T4 group, n = 14), and 3.00 D (SN60T5; T5 group, n = 23) at the IOL plane. The T5 group was subdivided into eyes that could be fully corrected (T5a, n = 13) and eyes that could be partially corrected (T5b, n = 10). RESULTS: Four months postoperatively, the mean uncorrected visual acuity (UCVA) was 0.77 +/- 0.23 in the T3 group, 0.93 +/- 0.23 in the T4 group, 0.82 +/- 0.15 in the T5a group, and 0.47 +/- 0.13 in the T5b group. More than 90% of the combined eyes in the T3, T4, and T5a groups achieved a UCVA of 20/40 or better, and almost 80% achieved a UCVA of 20/25 or better. Residual refractive astigmatism of less than 0.75 D was achieved in 74% of eyes and of less than 1.00 D in 91%. The mean IOL misalignment was 2.5 +/- 2.1 degrees in the T3 group, 3.5 +/- 2.3 degrees in the T4 group, and 4.1 +/- 3.5 degrees in the T5 group. CONCLUSION: Implantation of the AcrySof toric IOL proved to be an effective, safe, and predictable method of managing corneal astigmatism in cataract patients.

Intraocular straylight after implantation of the multifocal AcrySof ReSTOR SA60D3 diffractive intraocular lens.

PURPOSE: To measure intraocular straylight (as a measure of glare) after cataract surgery and implantation of an AcrySof ReSTOR SA60D3 multifocal or AcrySof SA60AT monofocal intraocular lens (IOL) (both Alcon Laboratories). SETTING: University Hospital Maastricht, Maastricht; Isala Clinics, Zwolle; Netherlands Institute for Neurosciences, Amsterdam, The Netherlands. METHODS: In a prospective open observational case series, a newly developed straylight meter was used to objectively measure straylight 6 months postoperatively in 66 eyes with a diffractive AcrySof ReSTOR SA60D3 IOL (multifocal group) and 40 eyes with a monofocal AcrySof SA60AT IOL (monofocal group). A comparison of straylight levels in an age-matched population without cataract (control group) was performed. RESULTS: The straylight level was 1.20 log units +/- 0.16 (SD) in the multifocal group and 1.10 +/- 0.19 log units in the monofocal group. When the difference in mean level of straylight was adjusted for age, mean straylight levels were 0.078 log units lower in the monofocal group than in the multifocal group (P = .026). Straylight levels in both pseudophakic groups were lower than in the control group without cataract (P< .0001). CONCLUSIONS: Levels of intraocular straylight log(s) were significantly lower for both types of IOL than in age-matched subjects from the normal population. The mean level of intraocular straylight 6 months postoperatively was higher in patients with an AcrySof ReSTOR SA60D3 IOL than in patients with a monofocal AcrySof SA60AT IOL. Implantation of the former IOL would therefore result in a smaller gain in contrast sensitivity and a smaller reduction in glare and halos than implantation of the latter IOL.

Use of Verisyse/Artisan phakic intraocular lens for the reduction of myopia in a patient with pellucid marginal degeneration.

PURPOSE: To describe a patient who underwent implantation of a Verisyse/Artisan iris-fixated phakic intraocular lens (IOL) for correction of high myopia in pellucid marginal degeneration (PMD). METHODS: A patient with PMD was observed during a period of 7 years after the implantation of a Verisyse/Artisan phakic IOL. At each visit, slit-lamp evaluation was performed, and corneal topography, endothelial cell count, manifest refraction, and uncorrected and best-corrected visual acuity were determined. RESULTS: Verisyse/Artisan phakic IOL implantation was performed for the correction of the patient's high myopia in the presence of early-stage PMD. The preoperative refraction of the right eye was -13.0 -3.0 x 90 degrees. The postoperative spherical equivalent (SE) was +0.50 D after 1 year and +0.50 D after 7 years. The preoperative refraction of the left eye was -13.0 -1.25 x 55 degrees. The postoperative SE was -0.38 D after 1 year and -0.13 D after 7 years. Preoperative topographic astigmatism for the right and left eye was 2.94 and 0.81 D, respectively. Seven years later, topographic astigmatism for the right and left eye had changed to 4.45 and 0.71 D, respectively. CONCLUSIONS: This case shows that the implantation of a Verisyse/Artisan phakic IOL may be effective in the treatment of refractive error in PMD. This case discusses the value of a removable (as opposed to a permanent) solution, such as the Verisyse/Artisan phakic IOL device, in the treatment of refractive error in PMD.