Clinical outcomes and surgeon assessment after implantation of a new diffractive multifocal toric intraocular lens

Repeatability of Pentacam-derived intraocular lens decentration measurements and the level of agreement with OPD-Scan III: A prospective observational case series

PURPOSE

This study aimed to assess the repeatability of intraocular lens (IOL) decentration measurements obtained through Pentacam, based on corneal topographic axis (CTA) and pupillary axis (PA), and to evaluate the level of agreement between Pentacam and OPD-Scan III devices in measuring IOL decentration.

METHODS

In this prospective observational case series, three measurements were performed with Pentacam to evaluate the repeatability of the measurements. The analysis included the calculation of the mean and standard deviations (SD), conducting a repeated measures analysis of variance (rANOVA), and determining an intraclass correlation coefficient (ICC) to assess the repeatability of the measurements. Moreover, Bland-Altman analysis was employed to assess the agreement between Pentacam and OPD-Scan III devices in measuring IOL decentration. IOL decentration measurements were obtained with respect to both CTA and PA.

RESULTS

A total of 40 eyes from 40 patients were analyzed. The rANOVA revealed no significant difference among three consecutive measurements of IOL decentration obtained with Pentacam. The mean SD of all parameters ranged from 0.04 mm to 0.07 mm. With CTA as the reference axis, the ICC values for Pentacam measurements of IOL decentration were 0.82 mm for the X-axis, 0.76 mm for the Y-axis, and 0.82 mm for spatial distance. When using PA as the reference axis, the corresponding ICC values were 0.87, 0.89, and 0.77, respectively. The 95% limits of agreement for all IOL decentration measurements were wide when comparing Pentacam and OPD-Scan III.

CONCLUSIONS

Pentacam demonstrated high repeatability in measuring IOL decentration with respect to both CTA and PA. However, due to poor agreement between Pentacam and OPD-Scan III measurements, caution should be exercised when using data interchangeably between the two devices.

Comparison of cataract patients with regular corneal astigmatism after implantation of extended range-of-vision and bifocal toric intraocular lenses

Purpose

To compare the postoperative visual acuity and visual quality between extended range-of-vision and multifocal toric intraocular lens (IOLs) after implantation in cataract patients with regular corneal astigmatism.

Setting

Department of Ophthalmology, the Second Hospital of Jilin University, Changchun, Jilin Province, China.

Design

Retrospective and single-center study.

Methods

The study involved implanting the Tecnis Symphony (ZXR00IOL) or the bifocal toric (ZMTIOL) in patients undergoing cataract surgery. Three months after surgery, lens performance was evaluated using distance, intermediate, and near visual acuity tests, defocus curves, the modulation transfer function (MTF), a visual function index questionnaire (VF-14), and the adverse optical interference phenomena.

Results

The 3-month postoperative follow-up found that both groups had good corrected distance vision. The ZMT group had better-uncorrected distance visual acuity and near visual acuity (p < 0.05). However, the ZXR group showed better uncorrected intermediate visual acuity (p < 0.05) and visual continuity. Overall astigmatism in the postoperative ZMT group was significantly lower than that in the pre-operative group (p < 0.05). The ZMT group had lower total high-order aberrations (tHOs), higher MTF values, and higher VF-14 scores (p < 0.05). Finally, the ZXR group exhibited reduced halo and glare phenomena (p < 0.05).

Conclusion

We found that ZMT can effectively correct a corneal astigmatism of 1.0-1.5 D and ZXR can improve patient outcomes regarding subjective optical quality and range of vision. These findings have the potential to improve future astigmatism treatment options.

Evaluating Changes in Apparent Chord Mu after Pharmacological Pupil Dilatation

INTRODUCTION

Preoperative measurements of apparent chord mu length above 0.6 mm have been associated with higher risks for photic phenomena after cataract surgery with multifocal intraocular lenses (MFIOLs).

METHODS

This retrospective study evaluated patients scheduled for elective cataract surgery at a single tertiary medical center between 2021 and 2022. Pupil diameter and apparent chord mu length were analyzed for eyes with biometry measurements from IOLMaster 700 (Carl Zeiss Meditec, AG) under photopic light conditions, before and after pharmacological pupil dilatation. Exclusion criteria were visual acuity worse than 20/100, prior intraocular surgery, refractive surgery, iris-related procedures, or pupil abnormalities affecting dilatation. Apparent chord mu lengths before and after pupil dilatation were compared. In addition, multivariate linear regression analysis, using a stepwise method, was conducted to assess possible predictors of apparent chord values.

RESULTS

Included were 87 eyes of 87 patients. Mean chord mu length increased after pupillary dilatation from 0.32 ± 0.17 mm to 0.41 ± 0.17 mm for right eyes (p < 0.001) and from 0.29 ± 0.16 mm to 0.40 ± 0.22 mm for left eyes (p < 0.001). Seven eyes (8.0%) had an apparent chord mu of 0.6 mm and above pre-dilatation. Fourteen eyes (16.1%) with an apparent chord mu under 0.6 mm pre-dilatation had apparent chord mu of 0.6 mm or above post-dilatation.

CONCLUSION

Apparent chord mu length significantly increases after pharmacological pupillary dilatation. Pupil size and dilatation status should always be considered during patient selection for a planned MFIOL using apparent chord mu length as a reference marker.

Evaluation of the Effects of Multifocal Intraocular Lens Oculentis LENTIS Mplus LS-313 MF30 on Visual Performance in Patients Affected by Bilateral Cataract and Treated with Phacoemulsification

Background

The purpose of this study was to evaluate the visual results and patients' satisfaction with surgical treatment of phacoemulsification and implantation of the innovative intraocular multifocal lens (MFIOL) Oculentis LENTIS Mplus MF30 in patients with bilateral cataracts.

Materials and Methods

A single-center prospective observational study was conducted on a total of 20 patients with bilateral cataracts. We evaluated the monocular UCVA and BCVA at 1 day, 7 days, 1 month, 3 months, and 6 months at different distances after phacoemulsification and MFIOL implantation and the binocular UCVA at the same distances. We also assessed the frequency of visual disturbances, overall visual satisfaction, spectacles dependence, and ease of performing different daily activities.

Results

The MFIOL Mplus MF30 was able to significantly improve the monocular UCVA and BCVA at all working distances. Overall visual satisfaction was above 9/10 in all postoperative observation intervals. The degree of independence from spectacles at all distances was 100%. The frequency of adverse visual phenomena was minimal.

Conclusions

In accordance with the literature, the Oculentis LENTIS Mplus MF30 has proved to be a valid therapeutic alternative for visual rehabilitation after phacoemulsification of the cataract in patients also wishing to treat presbyopia, at the cost of very few visual adverse effects. Trials Registration. This trial is registered with ISRCTN20862627.

Comparison of trifocal toric and bifocal toric intraocular lens implantation in patients with cataract and high corneal astigmatism

AIM

To investigate and compare the quality of life, satisfaction, contrast sensitivity, glare, depth perception, and intraocular lens (IOL) rotation in patients who underwent trifocal toric and bifocal toric IOLs.

METHODS

A total of 80 eyes of 40 patients were included in this prospective study. Twenty patients in each group were implanted with trifocal toric and bifocal toric IOL, respectively. Preoperative and postoperative 6-month measurements were recorded for both patient groups. Comprehensive anterior and posterior segment examinations, distance-intermediate-near visual acuity values and the visual function scale questionnaire results were evaluated at these examinations. Patient satisfaction, contrast sensitivity, glare, intermediate-near and distance stereopsis and IOL rotation were also evaluated.

RESULTS

No significant difference was found between the groups in terms of distance and near visual acuities (P=0.269, P=0.451). Intermediate visual acuity was significantly increased in the trifocal toric group (P<0.001). The visual function scale results were increased after surgery in both groups (P=0.001 and P<0.001), with no difference determined between them (P=0.158 and P=0.691). The number of patients wearing glasses was low in both groups and there was no significant difference between the groups (P>0.05). The overall satisfaction in the trifocal toric group was significantly higher than in the bifocal toric group (P=0.03). The highest sensitivity was observed at 6 cpd spatial frequency in all patients under photopic conditions (1.80±0.24 logU, 1.74±0.20 logU). Distance-intermediate-near binocular depth perception results in both groups were higher in the trifocal toric group (P=0.02, 0.048, 0.003, respectively). Although there was no significant difference for 3 meters stereopsis, the trifocal toric group had higher depth perception (P=0.577). Mean rotation was 5.76°±3.93° in the trifocal toric group and 12°±7.1° in the bifocal toric group.

CONCLUSION

Better results in the middle distance are obtained in the trifocal toric group and less IOL rotation due to digital system-coordinated surgery. Moreover, the overall satisfaction in the trifocal toric group is significantly higher than in the bifocal toric group.

Long-term changes in the refractive effect of a toric intraocular lens on astigmatism correction

Purpose

To examine the long-term changes in the astigmatism-correcting effect of a toric intraocular lens (IOL) after stabilization of surgically induced astigmatic changes due to cataract surgery.

Methods

Unilateral eyes of 120 patients that received a toric IOL for against-the-rule (ATR) or with-the-rule (WTR) astigmatism were enrolled. Manifest refractive and anterior corneal astigmatism, and ocular residual astigmatism which is mainly derived from internal optics were examined preoperatively, at approximately 2 months postoperatively (baseline) and at 5 ~ 10 years postbaseline. The astigmatism was decomposed to vertical/horizontal (Rx) and oblique components (Ry), which was compared between baseline and 5 ~ 10 years postbaseline.

Results

In the eyes having ATR astigmatism, the mean Rx and Ry of the manifest refractive and corneal astigmatism significantly changed toward ATR astigmatism between the baseline and 5 ~ 10 years postbaseline (p ≤ 0.0304), but those of ocular residual astigmatism did not change significantly between the 2 time points. In the eyes having WTR astigmatism, the Rx and Ry of refractive, corneal, and ocular residual astigmatism did not change significantly between the 2 time points. Double-angle plots revealed an ATR shift in refractive and corneal astigmatism and no marked change in the ocular residual astigmatism in the eyes with ATR astigmatism, and there is no change in this astigmatism in the eyes with WTR astigmatism.

Conclusion

The long-term changes with age in the effect of a toric IOL significantly deteriorated due to an ATR shift of corneal astigmatism in the eyes having ATR astigmatism, while it was maintained in eyes having WTR astigmatism, suggesting that ATR astigmatism should be overcorrected.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00417-021-05406-7.

Effect of Refractive Astigmatism on All-Distance Visual Acuity in Eyes With a Trifocal Intraocular Lens

PURPOSE

To investigate the effect of refractive astigmatism on all-distance visual acuity (VA) in eyes implanted with a diffractive trifocal or bifocal intraocular lens (IOL).

DESIGN

Cross-sectional study.

METHODS

Fifty eyes with trifocal IOLs (PanOptix; Alcon) and 50 eyes with bifocal IOLs (ReSTOR +3D) were enrolled. After simulating astigmatism by adding cylindrical lenses of 0, 0.5, 0.75, 1.0, and 1.5 diopters (D), the corrected logarithm of minimal angle of resolution (logMAR) VA was measured using an all-distance vision tester.

RESULTS

Mean VAs at most distances significantly worsened in proportion to the added astigmatism (P ≤ .0111) with no significant differences in near VA at 0.3 m in the trifocal group or in intermediate VA at 0.7 m in the bifocal group. Mean intermediate VA at 0.5 m was significantly better in the trifocal group than in the bifocal group when the astigmatism was 0.75 D or less (P ≤ .0472), but VA at distances of ∞ and 5.0 m were significantly worse in the trifocal group when the astigmatism was 0.5 D or more (P ≤ .0457). Useful mean logMAR VA of 0.20 was achieved at all distances when the astigmatism was 0.75 D or less in the trifocal group and 1.0 D or less in the bifocal group.

CONCLUSIONS

All-distance VA, particularly distance VA, worsened more in proportion to astigmatism with a trifocal IOL than with a bifocal IOL. Useful VA was achieved when the astigmatism was 0.75 D or less with a trifocal IOL, suggesting that astigmatism correction is necessary when astigmatism is more than 0.75 D.

FOCUSED (Femtosecond Optimized Continuous Uncorrected Sight with EDOF and Diffractive Multifocal IOLs) - A Review

PURPOSE OF REVIEW

The aim of this article is to review techniques to maximize all-distance uncorrected visual acuity and minimize photic phenomena after the implantation of multifocal and extended-depth of focus (EDOF) intraocular lenses (IOLs). This review examines the role of femtosecond laser-assisted cataract surgery (FLACS) in postoperative minimization of astigmatism and optimization of outcomes with multifocal and EDOF lenses.

RECENT FINDINGS

By incorporating intraoperative and preoperative imaging, femtosecond platforms such as those that utilize iris or conjunctival vessel registration, can enable a precision of corneal incisions and toric IOL markings that enable the lowest possible postoperative levels of astigmatism. Current studies suggest that with increasing IOL complexity, that is, trifocal versus bifocal, image degradation with even low levels of postoperative astigmatism are increased. To this end, current data support the utility of femtosecond laser arcuate incisions to enable the achievement of 0.5 D or less postoperative astigmatism for best outcomes with multifocal lenses.

SUMMARY

The synergistic combination of multifocal/EDOF IOLs with FLACS is an extremely promising route in achieving postoperative spectacle independence for patients. The marriage of the precision of FLACS with the increasing complexity of multifocal/EDOF IOLs will fuel nomogram adjustment and systematic improvements, such as the Wörtz-Gupta formula. Such strategies provide an unprecedented precision to cataract surgery that makes FOCUSED (Femtosecond Optimized Continuous Uncorrected Sight with EDOF and Diffractive Multifocal IOLs) a reality.

Clinical outcomes with a new design in multifocal intraocular lens: a pilot study

Purpose

To evaluate the clinical and visual outcomes, quality of near vision and the influence of photic phenomena in patients bilaterally implanted with a new Precizon Presbyopic multifocal intraocular lens (IOL).

Methods

In this prospective consecutive case series, 20 eyes of 10 patients were included (mean age 63.80 ± 12.55 years). Uncorrected and corrected visual acuity (far, intermediate and near), subjective refraction, binocular defocus curve, contrast sensitivity (CSV-1000) and quality of vision and satisfaction questionnaires were measured. The follow-up was 12 months after surgery.

Results

At 12 months after surgery, uncorrected distance visual acuity (UDVA) improved with surgery (p = 0.001) with a value of 0.08 ± 0.08 logMAR. Uncorrected near visual acuity (UNVA) was 0.22 ± 0.12 logMAR and distance corrected near visual acuity (DCNVA) was 0.16 ± 0.13 logMAR. Intermediate distance visual acuity (UIVA) was 0.22 ± 0.10 logMAR. Contrast sensitivity outcomes were similar to normal population in photopic conditions and slightly reduced in mesopic conditions of lighting. Defocus curve showed that this multifocal IOL was able to provide a visual acuity (VA) equal or better to 0.16 logMAR between defocus levels of + 1.00 to − 2.50 D. Good patient satisfaction was obtained in quality of vision and satisfaction questionnaires outcomes.

Conclusions

The Precizon Presbyopic NVA IOL (OPHTEC BV) provides good visual outcomes. This multifocal IOL provides a high percentage of spectacle independence due to good VA at far, intermediate and near distances and satisfactory contrast sensitivity. High patient satisfaction was observed in quality of vision and satisfaction questionnaires with a low percentage of patients manifesting photic phenomena.

Which intraocular lens would ophthalmologists choose for themselves?

PURPOSE

Contemporary cataract surgery is increasingly customizable with the advent of presbyopia-correcting intraocular lenses (IOLs) and the femtosecond laser. The purpose of this study was to determine the types of IOLs ophthalmologists choose for themselves and whether demographic characteristics, surgical experience, and attitudes of ophthalmologists might influence their decision-making. Additional goals included evaluating the use of femtosecond laser use in cataract surgery and investigating surgeon IOL preferences for their patients.

METHODS

We distributed a 29-question Survey Monkey survey to senior ophthalmology residents and practicing ophthalmologists and received 347 responses during a 1-month period. We analyzed 328 surveys using chi-square tests and Fisher's exact tests.

RESULTS

Main outcome measures included surgeons' personal preferences for choice of IOL, femtosecond laser-assisted cataract surgery, and IOL preference for patients. In the setting of no astigmatism, 61.3% of respondents would choose a monofocal IOL set for either distance or monovision for their own surgery. For corneal astigmatism >1.25 D, 60.3% of respondents would choose a toric monofocal lens and only 6.9% would want a femtosecond laser or manual LRI for their own surgery. Of the respondents, 34.6% perform femtosecond laser-assisted cataract surgery, but only 15.3% would want femtosecond cataract surgery performed on themselves. Also, 67.7% implant presbyopia-correcting IOLs (diffractive echelette, multifocal, or accommodative). When correcting for patients' corneal astigmatism >1.25 D, 65.7% of respondents preferred a toric monofocal IOL.

CONCLUSION

Ophthalmologists value quality of vision and are risk averse. Overall, a surgeons' personal preference for their own surgery is correlated with past surgical experience with patients.

Patient outcomes following implantation with a trifocal toric IOL: twelve-month prospective multicentre study

PURPOSE

To evaluate clinical outcomes with a premium diffractive-refractive trifocal toric intraocular lens (IOL) over a 12-month period.

METHODS

Multicentre prospective clinical trial including 227 eyes of 114 patients undergoing cataract surgery with bilateral implantation of the AT LISA tri toric 939MP IOL (Carl Zeiss Meditec, Jena, Germany). One patient was implanted unilaterally. Outcome measures were: visual acuity, manifest refraction, reading performance, contrast sensitivity, defocus curve, patient satisfaction and subjective quality of vision. Alpins vector analysis was used to evaluate astigmatic changes.

RESULTS

12-month follow up results of binocular uncorrected distance, intermediate and near visual acuity were ≤0.3 logMAR in 99.0%, 98.10% and 91.40% of eyes, respectively. 79.7% of eyes had a cylinder value of ±0.50 D at 12 months post-surgery. Contrast sensitivity was in the normal range at 6 months post-surgery. The defocus curve exhibited a smooth transition between far and near foci. Vector analysis showed a mean magnitude of error of -0.16 ± 0.48 D. Mean binocular distance-corrected reading visual acuity was 0.15 ± 0.13 logRAD at 6 months postoperatively. 93.3%, 89.4% and 84.6% of patients expressed satisfaction (good or very good) with distance, intermediate and near vision, respectively, 12 months after surgery. Most (≥95%) patients felt that visual disturbances, including halos, glare, focusing difficulties and depth perception, caused little or no disturbance.

CONCLUSIONS

The diffractive-refractive trifocal toric IOL, AT LISA tri toric 939MP, provides effective distance, intermediate and near visual acuity in eyes with corneal astigmatism. Patient satisfaction was high and 98.1% of patients expressed satisfaction with the IOL implanted.

Premium intraocular lenses: The past, present and future

Purpose

To present potential benefits as well as limitations of premium intraocular lens (IOL) use, and provide insight in future of premium cataract surgery.

Methods

Bibliographic research was performed in PubMed/Medline database, and the most recently updated papers were evaluated. Keywords used were: premium intraocular lens, multifocal intraocular lens, toric intraocular lens, toric multifocal intraocular lens, accommodative intraocular lens, and the respective brand names.

Results

Multifocal IOLs provide uncorrected distance visual acuity (UDVA) of 0.03 logMAR in 82.3%–95.7% of patients and overall spectacle independence in 81%–85% of patients. Toric IOLs provide UDVA of 0.3 logMAR in 70%–95% of patients, residual astigmatism of 1 D or less is noted in 67%–88% of patients, and spectacle independence is reported in 60%–85% of patients. Toric multifocal IOLs provide UDVA of 0.3 logMAR in 92%–97% of patients, and spectacle independence is reported in 79%–90% of patients. Accommodative IOLs represent intensively developing field in ophthalmology, and the results are still variable depending on the IOL model.

Conclusions

Premium IOL technology and advanced surgical techniques have significantly improved postoperative visual outcomes. Future developments will potentiate development of new premium IOL designs that will provide spectacle independence and excellent visual outcomes after cataract surgery.

Inferior Decentration of Multifocal Intraocular Lenses in Myopic Eyes

PURPOSE

To investigate the tilt and decentration of multifocal intraocular lenses (MfIOLs) implanted in myopic eyes.

DESIGN

A prospective cohort study.

METHODS

Twenty-eight myopic eyes and 56 emmetropic eyes were evaluated. Phacoemulsification with Tecnis ZMB00 MfIOL (Abbott Medical Optics, Santa Ana, California, USA) implantation was performed. At 1 year post-surgery, routine postoperative examinations were performed, and tilt and decentration of the MfIOLs, high-order aberrations, and modulation transfer function (MTF) were evaluated using the OPD-Scan III aberrometer (Nidek Co, Ltd, Gamagori, Japan). Subjective symptoms were assessed with a Quality of Vision questionnaire.

RESULTS

Postoperative uncorrected distance visual acuity (VA), best-corrected distance VA, and uncorrected near VA did not differ between the 2 groups. The mean IOL tilt and horizontal decentration were not different between the control and myopic groups. However, the myopic group presented significantly inferior decentration in the capsular bag compared with the control group (-0.03 ± 0.22 mm vs -0.21 ± 0.29 mm, P = .002). The overall decentration values were 0.32 ± 0.14 mm in the controls and 0.40 ± 0.18 mm in the myopic group (P = .023). Axial length was negatively correlated with vertical decentration (r = -0.268, P = 0.014) and positively correlated with overall decentration (r = 0.334, P = .002). Worse aberration data, poorer MTF, and more subjective symptoms were also found in the myopic group than in the controls.

CONCLUSION

Greater inferior decentration of MfIOLs and a consequent decrease in visual quality were found in myopic eyes, indicating that the increasing incompatibility between IOL and capsular bag size with axial length elongation should not be underestimated.

Clinical outcomes of new toric trifocal diffractive intraocular lens in patients with cataract and stable keratoconus: Six months follow-up

PURPOSE

To evaluate the clinical results of toric trifocal diffractive intraocular lens in eyes with cataract and mild keratoconus.

METHODS

Five keratoconus patients (10 eyes) that had bilateral AT LISA 939 implantation were selected and had followed in 3-time horizons of 1, 3, and 6 months. Patients were 46 to 65 years old age, corneal astigmatism of (2.00 D at 6.75 D) and cataract that all of them needed cataract surgery. The distance, intermediate and near visual acuities, defocus curve, ocular aberrations, contrast sensitivity, were measured as effectiveness criteria.

RESULTS

Average of binocular uncorrected distance visual acuity (UDVA) improved from 0.72 log MAR ± 0.11 (SD) to 0.04 ± 0.04 (P < 0.05) log MAR, average of uncorrected binocular intermediate visual acuity (UIVA) (80 cm) improved from 0.52 ± 0.07 log MAR to 0.14 ± 0.04 (P < 0.05) log MAR, and average of binocular uncorrected near visual acuity (UNVA) improved from 0.48 ± 0.09 log MAR to 0.02 ± 0.07 (P < 0.05) log MAR at 6 months, respectively. Contrast sensitivity testing showed acceptable results, the binocular defocus curve corroborate were in appropriate good visual acuity even at the intermediate distances, by a gentle slope less than log MAR 0.2 at -1.5 D, with regard to the best distance visual acuity at the 0 D defocus.

CONCLUSIONS

Trifocal AT LISA 939MP IOLs provided appropriate distances, near and intermediate of the visual results. Prediction of the refractive results and optical performances were good.

Visual outcomes of a new toric trifocal diffractive intraocular lens

PURPOSE

To evaluate the visual, refractive, contrast sensitivity, and aberrometric outcomes as well as the patient quality of life and photic phenomena disturbances after cataract surgery with implantation of a new trifocal toric intraocular lens (IOL).

SETTINGS

Premium Clinic, Regional Hospital in Havlickuv Brod, Czech Republic, and Vissum and Universidad Miguel Hernández, Alicante, Spain.

DESIGN

Prospective consecutive series of cases.

METHODS

The study involved eyes with corneal astigmatism of 1.25 D or more that were having cataract surgery with implantation of the trifocal toric IOL AT Lisa tri toric 939MP (Carl Zeiss Meditec). Visual outcomes and astigmatic changes analyzed by Alpins vector analysis were evaluated at 3 months postoperatively. Contrast sensitivity, quality of life, and photic phenomena were also evaluated.

RESULTS

The study involved a total of 30 eyes of 16 patients, age 37 to 64 years. A significant improvement with surgery was observed in uncorrected distance, intermediate, and near visual acuity (P ≤ .01). A significant decrease in the refractive cylinder was observed postoperatively (P < .01), with all eyes showing a postoperative astigmatism below 1.00 D. The difference between targeted and surgically induced astigmatism was small (0.06 ± 0.30 D) but statistically significant (P = .04). The mean magnitude of angle of error was 5.80 ± 8.47 degrees. The low levels of higher-order aberrations found postoperatively were consistent with the good levels of contrast sensitivity achieved. Regarding quality of life, low to moderate levels of difficulty in performing various types of vision-related tasks were found.

CONCLUSIONS

The trifocal toric IOL evaluated provides effective restoration of visual function after cataract surgery, with associated high levels of visual acuities and quality of life.

FINANCIAL DISCLOSURE

The authors have no proprietary or commercial interest in the medical devices that are involved in this manuscript.

Rotation and decentration of an undersized plate-haptic trifocal toric intraocular lens in an eye with moderate myopia

We present the case of a 56-year-old woman with moderate myopia and bilateral cataract who had cataract extraction and intraocular lens (IOL) implantation. Due to the patient's desire for spectacle independence, a trifocal IOL with toric correction for astigmatism was implanted. During the follow-up, it became obvious that the implanted IOL had rotated and tilted due to insufficient fixation in the large capsular bag of the myopic eye. An IOL explantation was therefore performed, and the original IOL was exchanged for a bifocal toric IOL with a larger overall diameter. Stable fixation of the IOL in the capsular bag was achieved, and after surgery in the second eye, the patient recovered good bilateral vision. This case illustrates the need for careful selection of IOL diameter and sizing even in patients with moderate myopia due to the potentially larger ocular dimensions in these patients.

Clinical Outcomes After Implantation of a Trifocal Toric Intraocular Lens

PURPOSE

To evaluate the visual, refractive, and contrast sensitivity outcomes, as well as the level of photic phenomena, after cataract surgery with implantation of a trifocal diffractive toric intraocular lens (IOL).

METHODS

This prospective study included 56 eyes with corneal astigmatism of 1.00 diopters (D) or greater of 28 patients (age: 23 to 78 years) undergoing cataract surgery with implantation of the trifocal toric IOL AT LISA tri toric 939MP (Carl Zeiss Meditec, Jena, Germany). Monocular and binocular visual outcomes, refractive changes, contrast sensitivity, and photic phenomena perception (Halo & Glare Simulator; Eyeland-Design Network GmbH, Vreden, Germany) were evaluated at 3 months postoperatively.

RESULTS

Mean 3-month postoperative monocular uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuities were 0.13±0.15, 0.08±0.15, and 0.13±0.18 logMAR, respectively. Binocular postoperative CDVA, DCIVA, and DCNVA values were 0.10 logMAR or better in all cases. A total of 88.2%, 88.2%, and 95.5% of eyes achieved binocular UDVA, UIVA, and UNVA values of 0.20 logMAR or better, respectively. Postoperative refractive cylinder was 0.50 D or less and 1.00 D or less in 78.6% and 98.2% of eyes, respectively. Photopic contrast sensitivity was significantly better than mesopic values for the spatial frequencies of 6 (P=.007), 12 (P=.005), and 18 cycles/degree (P=.011). Mean size and intensity of halos were 50.67±15.69 and 54.89±17.86, respectively. Mean glare size and intensity were 39.67±3.51 and 44.67±15.01, respectively.

CONCLUSIONS

The evaluated trifocal diffractive toric IOL provides an effective restoration of the distance, intermediate, and near vision after cataract surgery with good levels of visual quality and minimal photic phenomena.