Visual outcomes and patient satisfaction after implantations of three types of presbyopia-correcting intraocular lenses that have undergone corneal refractive surgery.

This prospective, non-randomized, comparative study aimed to compare the visual outcomes and patient satisfaction after implantations of three presbyopia-correcting intraocular lenses (IOLs) after myopic refractive surgery. It was conducted from January 2020 to December 2021 in Shanghai Heping Eye Hospital. Patients were divided into three groups based on the type of IOL implanted. The visual acuity, refractive stability, high-order aberrations, objective visual quality, spectacle independence, and visual function index 14 questionnaire scores of the three groups were compared. This study included 78 eyes of 39 patients: 26 eyes with 839MP, 26 eyes with MF30, and 26 eyes with ZXR00. Uncorrected distance visual acuity improved significantly for all three groups. For a pupil diameter of 4.0 mm, the spherical aberrations of the three groups were 0.33 ± 0.16 µ, 0.50 ± 0.08 µ, and 0.39 ± 0.10 µ, respectively. The spectacle independence for distance vision was over 90% in each group; for near vision, it was only 25% for the ZXR00 group. All three types of presbyopia-correcting IOLs improved visual quality in post-LASIK or PRK patients. However, the high incidence of photic phenomena after presbyopia-correcting IOL implantation in patients who have undergone myopic LASIK should not be neglected.

Effect of astigmatism on visual outcomes after multifocal intraocular lens implantation: a systematic review and meta-analysis.

Purpose: To investigate the effects of postoperative astigmatism on the visual outcomes following presbyopia-correcting surgery with multifocal intraocular lens implantation. Methods: A comprehensive literature search was conducted using PubMed, Embase, and Web of Science for articles published until January 2023. Additionally, we included retrospective case series and prospective comparative studies. The combined mean difference (MD) with 95% confidence intervals (CI) and odds ratio (OR) with 95% CI were used to express continuous and categorical outcomes, respectively. All statistical analyses were performed using Review Manager (version 5.4.1). Results: We included nine eligible studies that analyzed 3,088 eyes. The proportion of eyes with useful postoperative visual acuity (logMAR ≤ 0.20) and residual astigmatism significantly differed with respect to the magnitude of astigmatism and presence/absence of blurred vision (p < 0.001 for both). Additionally, the mean uncorrected distance visual acuity (MD, 0.14; 95% CI, 0.06 to 0.21; p = 0.0003) and uncorrected intermediate visual acuity (MD, 0.07; 95% CI, 0.00 to 0.13; p = 0.04), but not the uncorrected near visual acuity (MD, 0.02; 95%CI-0.01 to 0.05; p = 0.17), significantly differed according to the magnitude of astigmatism. Conclusion: Astigmatism, even at low levels (≥ 0.5D), has a significant effect on visual outcomes, especially on UDVA and UIVA, following multifocal intraocular lens implantation. Accurate preoperative and postoperative evaluation of astigmatism is important.

Comparison of astigmatism correction and visual outcomes in mix-and-match implantations of trifocal intraocular lenses with femtosecond laser-assisted arcuate keratotomy and contralateral bifocal Toric intraocular lenses.

Introduction: Astigmatism reduces the postoperative visual performance after non-toric intraocular lenses (IOLs) implantation, and limits the use of refractive IOLs in cataract surgery. The purpose of this study was to compare the efficacy in astigmatism correction and the postoperative visual outcomes between the implantation of a trifocal IOL with femtosecond laser-assisted arcuate keratotomy (FSAK) in one eye and a bifocal toric IOL (TIOL) in the other, in patients with cataract and moderate astigmatism. Methods: This prospective observational paired-eye study enrolled patients with cataract and corneal astigmatism (CA) between 0.75 and 2.25 D in both eyes. The patients underwent a mix-and-match treatment comprising trifocal IOL implantation with FSAK and bifocal TIOL implantation. We compared the visual acuity (VA) at all distances, defocus curve, postoperative refractive astigmatism (RfA), CA, high-order aberrations, modulation transfer function (MTF) curve, and Strehl ratio between the two eye groups. Results: In total, 41 patients (82 eyes) were enrolled and completed a 6-month follow-up. The 1- and 3-month uncorrected distance VA and 3-month uncorrected near VA were greater in eyes with bifocal TIOLs than with trifocal IOLs and FSAK (p = 0.036, 0.010, and 0.030, respectively), whereas the latter had greater uncorrected intermediate VA at every visit and greater VA in the intermediate range of defocus curve (at -1.50 and - 2.00 D) than the eyes with bifocal TIOLs. The postoperative RA of the eyes with trifocal IOL and FSAK was significantly higher than that of the bifocal TIOL-implanted eyes at the 3- and 6-month follow-ups. Discussion: Both FSAK and TIOL implantation effectively reduce pre-existing moderate astigmatism in patients with cataract. The eyes with bifocal TIOLs had more stable long-term astigmatism correction, whereas those with trifocal IOLs and FSAK had better intermediate VA. Therefore, a mix-and-match implantation of trifocal IOL with FSAK and contralateral bifocal TIOL could achieve effective astigmatism correction and provide an overall optimal VA.

Binocular Visual Outcomes Comparison of Two Trifocal Intraocular Lenses in High-Myopic Cataract Patients: A 1-Year Multicenter Study.

PURPOSE: To compare the postoperative visual outcomes and quality of vision obtained with 2 types of diffractive trifocal intraocular lenses (IOLs) in patients with highly myopic cataracts. DESIGN: Prospective, multicenter, randomized controlled trial. METHODS: Patients with high-myopic cataracts were randomized to binocular implantation of either the TFNT00 (n = 27) or the 839 MP (n = 28) trifocal IOLs at 3 surgery centers in China and were followed up for 1 year. Postoperative uncorrected distance, uncorrected intermediate, and uncorrected near visual acuity, and best-corrected distance visual acuity were measured. The defocus curve, high-order aberrations, modulation transfer function curve, Strehl ratio, and reading ability were compared between both groups. The functional vision and incidence of photic phenomena were surveyed using questionnaires. RESULTS: Visual acuity at all ranges of vision was significantly improved in both groups. The TFNT00 group showed superior uncorrected intermediate visual acuity to that in the 839 MP group (P = .013). Reading ability at 40 and 60 cm was similar in both groups (P ≥ .05), whereas the preferred reading distances for near and intermediate were significantly different. The TFNT00 group had a significantly higher mean Visual Function Index 14 score, lower incidence of photic phenomena, and less posterior capsular opacity than the 839 MP group. CONCLUSION: Bilateral implantation of both types of trifocal IOLs in patients with high-myopic cataracts provided good whole-course visual restoration, although recognition of fine Chinese characters remained impeded. As compared with 839 MP IOL, TFNT00 IOL resulted in greater patient satisfaction in intermediate activities, with a lower photic phenomena incidence.