Multifocal Intraocular Lens Exchange in Patients with Ocular Comorbidities: Indications and Outcomes

Abstract Purpose: To investigate all cases of multifocal intraocular lens (MFIOL) exchange, with specific focus on indications for exchange and evaluation of postoperative outcomes, in a tertiary care, multi-specialty ophthalmology practice.Setting/Venue: Academic Referral Center/Cleveland Clinic Abu Dhabi – Abu Dhabi, United Arab EmiratesMethods: This retrospective case series identified all patients that presented to a large academic practice over a 4-year period that were intolerant to MFIOL technology and thus required intraocular lens (IOL) exchange. All patients reported poor vision despite correction of reversible ocular comorbidities, including dry eye and residual refractive error. Outcomes reviewed include subjective visual complaints, IOL-type, visual acuity, refractive error, ocular comorbidities, and surgical outcomes. Endpoints examined include mean uncorrected distance visual acuity (UDVA), mean corrected distance visual acuity (CDVA), mean refractive spherical equivalent (MRSE), and residual refractive astigmatism. Results: Six eyes of five patients required MFIOL exchange. All IOL’s exchanged were trifocal IOL’s. IOL exchange occurred between 6 to 72 months following primary phacoemulsification. Each patient had multiple ocular comorbidities, ranging from keratoconjunctivitis sicca to longstanding intermediate uveitis and macular pathology. Postoperatively, subjective visual complaints resolved in all patients. Objective mean changes in UDVA, CDVA, MRSE and residual astigmatism were not statistically significant. Conclusion: Thorough preoperative evaluation is required prior to MFIOL placement in order to rule out ocular comorbidities that may impair visual quality. In patients with MFIOL intolerance due to irreversible ocular comorbidities, IOL exchange to a monofocal IOL is safe, effective, and results in subjective improvement in vision.

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Bioptics for high hyperopia with combined multifocal intraocular lens implantation and excimer ablation in young patients

European Journal of Ophthalmology ◽

10.1177/1120672118797281 ◽

2018 ◽

Vol 29 (4) ◽

pp. 426-430 ◽

Cited By ~ 1

Author(s):

Omer Trivizki ◽

David Smadja ◽

Michael Mimouni ◽

Samuel Levinger ◽

Eliya Levinger

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Laser In Situ Keratomileusis ◽

Intraocular Lens Implantation ◽

Multifocal Intraocular Lens ◽

Distance Visual Acuity ◽

Lens Implantation ◽

Near Visual Acuity ◽

High Hyperopia

Purpose:To analyze the visual and refractive outcome of the bioptics procedure combining multifocal intraocular lens implantation and excimer laser surgery in young patients with high hyperopic eyes not suitable for a single surgical procedure.Methods:This retrospective case series included 10 eyes of five patients (age range 18–30 years) with high hyperopia (spherical equivalent +8.51 ± 0.85 diopters (D)). They had been treated with serial multifocal intraocular lens implantation followed 6 weeks later by laser in situ keratomileusis for residual hyperopia. Uncorrected distance visual acuity, uncorrected near visual acuity, corrected distance visual acuity, corrected near visual acuity, and manifest refraction were evaluated before surgeries, after multifocal intraocular lens implantation, and 3 months post laser in situ keratomileusis.Results:No patients were lost to follow-up (6 months). The mean spherical equivalent decreased to +2.05 ± 1.33 D after multifocal intraocular lens implantation and to −0.10 ± 0.58 D after the laser in situ keratomileusis procedure. Success of the procedures was determined by uncorrected visual acuity. LogMAR uncorrected distance visual acuity improved by a total of more than six lines from 1.05 ± 0.18 LogMAR to 0.46 ± 0.12 LogMAR post multifocal intraocular lens implantation and to 0.15 ± 0.06 LogMAR after both surgeries. The LogMAR uncorrected near visual acuity increased by 0.81 ± 0.82 LogMAR after lens implantation due to loss of accommodation, and all eyes reached a LogMAR of 0 at 1 month postoperatively following laser in situ keratomileusis.Conclusions:A bioptics approach involving multifocal intraocular lens followed 6 weeks later by a laser in situ keratomileusis procedure for the correction of very high hyperopia enabled the resolution of the residual refractive error in young very high hyperopic patients.

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Comparative Analysis of Visual Performance and Optical Quality with a Rotationally Asymmetric Multifocal Intraocular Lens and an Apodized Diffractive Multifocal Intraocular Lens

Journal of Ophthalmology ◽

10.1155/2020/7923045 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Xiao Wang ◽

Haixia Tu ◽

Yong Wang

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Intraocular Lens ◽

Visual Function ◽

Optical Quality ◽

Modulation Transfer ◽

Multifocal Intraocular Lens ◽

Distance Visual Acuity ◽

Age Related ◽

Significant Difference

Purpose. To compare the short-term visual outcomes and intraocular optical performance of a rotationally asymmetric multifocal intraocular lens (MIOL) (SBL-3, Lenstec, Inc., Christ Church, Barbados) and an apodized diffractive MIOL (the Acrysof IQ ResTOR SN6AD1, Alcon Laboratories, Inc., Fort Worth, Texas, United States). Methods. A prospective, comparative, nonrandomized, and single-center study. Sixty-eight age-related cataract patients (81 eyes) after phacoemulsification cataract surgery and in-the-bag MIOL implantation were enrolled. Thirty-eight eyes received SBL-3, and 43 eyes received SN6AD1. Ophthalmological evaluation included uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), modulation transfer function (MTF), Strehl ratio (SR), intraocular aberrations (4 mm optical zone), and defocus curve at 3 months postoperatively. The Chinese version of the visual function index-14 (VF-12-CN) and spectacle independence were assessed in all patients. Results. There was no statistically significant difference between groups in postoperative UDVA (p=0.186). Postoperative UIVA and UNVA were significantly better for the SBL-3 group than for the SN6AD1 group (p<0.01). Statistically significant differences were revealed in defocus levels from –3.50 D to −4.00 D with better visual acuities for the SBL-3 group (p<0.01). For intraocular optical quality outcomes, statistically significant differences between groups were observed in RMS of intraocular total aberrations, coma, and trefoil high-order aberrations, presenting significantly higher values of these parameters in the eyes of the SBL-3 group (p < 0.01). Statistically significant differences were revealed in the MTF values at spatial frequencies of 5 and 10 cycles/degree between groups. There were no significant differences in scores of VF-12-CN, and spectacle independence between the groups (p>0.05). Conclusions. Both MIOLs were able to successfully restore visual function after cataract surgery. SBL-3 provided better UIVA and UNVA with a wider range of intermediate vision.

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Effect of postoperative refractive error on visual acuity and patient satisfaction after implantation of the Array multifocal intraocular lens

Journal of Cataract & Refractive Surgery ◽

10.1016/j.jcrs.2005.03.062 ◽

2005 ◽

Vol 31 (10) ◽

pp. 1960-1965 ◽

Cited By ~ 17

Author(s):

Eun Suk Lee ◽

Sang Yeul Lee ◽

Soo Yong Jeong ◽

Yeon Sung Moon ◽

Hee Seung Chin ◽

...

Keyword(s):

Visual Acuity ◽

Patient Satisfaction ◽

Intraocular Lens ◽

Refractive Error ◽

Multifocal Intraocular Lens

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Clinical and Self-Reported Outcomes after Multifocal Intraocular Lens Implantation of Patients with Stable Keratoconus

10.21203/rs.3.rs-294653/v1 ◽

2021 ◽

Author(s):

Igor Šivec Trampuž ◽

Kristina Mikek ◽

Metka Krampf

Keyword(s):

Visual Acuity ◽

Patient Satisfaction ◽

Intraocular Lens ◽

Case Reports ◽

Multifocal Intraocular Lens ◽

Iol Implantation ◽

Distance Visual Acuity ◽

Refractive Outcomes ◽

Uncorrected Distance Visual Acuity ◽

Trifocal Iol

Abstract Background: Multifocal intraocular lens (IOL) implantation is generally not considered in patients with keratoconus; however, it may provide good optical results in selected patients with stage I and II keratoconus based on two case reports. Aims: To evaluate patient satisfaction and clinical outcomes in this patient population.Methods: This is a retrospective single-center, non-interventional, non-comparison study. All patients with frank keratoconus who had undergone a trifocal IOL implantation between 2016 and 2019 were invited to participate in this study (18 eyes of 9 patients). Postoperatively, refractive outcomes, contrast sensitivity, and ocular aberrations were recorded. A questionnaire was used for determining patient satisfaction and their quality of life. The mean follow-up time was 31.22 ± 6.38 months.Results: Postoperatively the patients’ uncorrected distance visual acuity improved from 1.13 ± 0.93 to 0.10 ± 0.17 (p˂0.001), corrected distance visual acuity went from 0.10 ± 0.11 to 0.05 ± 0.09 (p=0.19), mean refractive spherical equivalent changed from -4.34 ± 4.31 to 0.05 ± 0.51 D (p˂0.001), and manifest astigmatism from 2.44 ± 1.92 to 0.88 ± 1.81 D (p=0.017). A target refraction of less than ± 0.50 D was achieved in 17 eyes (94%) and one eye exhibited a hyperopic MRSE of +2.0 D. Three eyes (17%) lost 1 line of best corrected visual acuity and no patient lost two or more lines. The patients were independent of glasses in 78% for all distances. Conclusions: A trifocal IOL currently gives relatively good, predictable results with most patients feeling satisfied with the results of spectacle independence for all distances.

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All-distance visual acuity in eyes with a nontinted or a yellow-tinted diffractive multifocal intraocular lens

Japanese Journal of Ophthalmology ◽

10.1007/s10384-008-0626-7 ◽

2009 ◽

Vol 53 (2) ◽

pp. 100-106 ◽

Cited By ~ 13

Author(s):

Ken Hayashi ◽

Miki Masumoto ◽

Hideyuki Hayashi

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Multifocal Intraocular Lens ◽

Distance Visual Acuity

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All-Distance Visual Acuity and Contrast Visual Acuity in Eyes with a Refractive Multifocal Intraocular Lens with Minimal Added Power

Ophthalmology ◽

10.1016/j.ophtha.2008.09.052 ◽

2009 ◽

Vol 116 (3) ◽

pp. 401-408 ◽

Cited By ~ 22

Author(s):

Ken Hayashi ◽

Motoaki Yoshida ◽

Hideyuki Hayashi

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Multifocal Intraocular Lens ◽

Distance Visual Acuity

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Outcomes of refractive error correction in pseudophakic patients using a sulcus piggyback intraocular lens

European Journal of Ophthalmology ◽

10.1177/1120672120903560 ◽

2020 ◽

pp. 112067212090356

Author(s):

Eliya Levinger ◽

Michael Mimouni ◽

Yaron Finkelman ◽

Yossi Yatziv ◽

Jonathan Shahar ◽

...

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Intraocular Lens ◽

Refractive Error ◽

Spherical Equivalent ◽

Distance Visual Acuity ◽

Refractive Outcomes ◽

Uncorrected Distance Visual Acuity ◽

Corrected Distance Visual Acuity

Purpose: The purpose of this study was to assess the results of a sulcus intraocular lens (Sulcoflex) for pseudophakic refractive errors following phacoemulsification cataract surgery. Methods: This retrospective clinical observational cohort study included consecutive eyes in which a Sulcoflex was implanted. Uncorrected distance visual acuity and corrected distance visual acuity as well as refractive outcomes were assessed. The minimum follow-up time required for inclusion was 3 months. Results: In total, 15 eyes ( n = 15) were evaluated. The mean follow-up was 14 months (range: 3–18 months). The Sulcoflex aspheric (653L) was implanted in 13 eyes and the Sulcoflex toric (653T) in two eyes. The preoperative mean logMAR (Snellen) uncorrected distance visual acuity and corrected distance visual acuity were 0.88 (20/150) and 0.27 (20/40), respectively. The postoperative mean logMAR (Snellen) corrected distance visual acuity was 0.15 (20/30). The preoperative mean spherical equivalent was −0.22 ± 5.95 D and the postoperative mean spherical equivalent was −1.59 ± 1.45 D. There was a significant and strong correlation ( r = 0.64, p < 0.001) between the attempted and the achieved spherical equivalent. Conclusion: The Sulcoflex is a safe and viable option for patients with residual refractive error following cataract surgery.

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Cases of replacing diffractive bifocal intraocular lens with extended depth of focus intraocular lens due to waxy vision

PLoS ONE ◽

10.1371/journal.pone.0259470 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0259470

Author(s):

Ryu Takabatake ◽

Makiko Takahashi ◽

Takuya Yoshimoto ◽

Fumiaki Higashijima ◽

Yuka Kobayashi ◽

...

Keyword(s):

Visual Acuity ◽

Contrast Sensitivity ◽

Intraocular Lens ◽

Depth Of Focus ◽

Iol Implantation ◽

Distance Visual Acuity ◽

Extended Depth Of Focus ◽

Good Visual Acuity ◽

Bifocal Intraocular Lens ◽

Iol Exchange

Purpose To investigate the postoperative course of patients who explanted a diffractive bifocal intraocular lens (IOL) due to waxy vision and implanted with an extended depth of focus IOL. Methods This study evaluated 29 eyes of 25 patients who underwent diffractive bifocal IOL explantation followed by TECNIS Symfony® implantation because of dissatisfaction due to waxy vision at the Takabatake West Eye Clinic between January 2018 and November 2019. The indication criteria for this surgery were patients with uncorrected distance visual acuity of 0.05 logMAR or better, without eye diseases that may affect visual function, and no dissatisfactions about photic phenomena. We investigated patient demographics, uncorrected and corrected visual acuity, manifest refraction, contrast sensitivity, subjective symptoms, time to IOL explantation, explanted IOL type, and spectacle independence. Results The time to the IOL exchange after the initial IOL implantation was 55.3 ± 50.4 days (range: 14–196 days). The logMAR corrected distance visual acuity before and after IOL exchange were −0.13 ± 0.06 and −0.14 ± 0.06, respectively (p = 0.273). After IOL exchange surgery, the area under log contrast sensitivity function increased significantly from 1.07 ± 0.12 to 1.21 ± 0.12 (p < 0.001), and the waxy vision symptoms improved. The spectacle independence rate at the last visit was 88.0%. Conclusion For patients who complain of waxy vision despite good visual acuity after diffractive bifocal IOL implantation, exchange to extended depth of focus IOL was considered one of the useful surgical options.

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Early Results with a New Posterior Chamber Phakic Intraocular Lens in Patients with High Myopia

Journal of Ophthalmology ◽

10.1155/2018/1329874 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

Dilek Yaşa ◽

Ufuk Ürdem ◽

Alper Ağca ◽

Yusuf Yildirim ◽

Burçin Kepez Yildiz ◽

...

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Intraocular Lens ◽

High Myopia ◽

Posterior Chamber ◽

Phakic Intraocular Lens ◽

Phakic Iol ◽

Distance Visual Acuity ◽

Early Results ◽

Manifest Refraction

Purpose. To report clinical results of a foldable, hydrophilic acrylic, single-piece, injectable, posterior chamber phakic intraocular lens (pIOL).Material and Methods. Medical records of patients who underwent posterior chamber phakic IOL (Eyecryl Phakic IOL, Biotech Vision Care, Ahmedabad, India) implantation for surgical correction of myopia were retrospectively reviewed. Only patients with at least a one-year follow-up were included. Manifest refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), endothelial cell density (ECD), and pIOL vault were analyzed at 1, 3, 6, and 12 months after surgery. Complications observed during and after surgery were also recorded.Results. The study included 58 eyes of 29 patients. Mean patient age was 32 ± 7 years. Spherical equivalent of manifest refraction was −13.41 ± 3.23 D preoperatively and −0.44 ± 0.55 D postoperatively. Preoperative CDVA was 0.29 ± 0.71 logMAR. Postoperative UDVA and CDVA were 0.21 ± 0.66 and 0.15 ± 0.69 logMAR, respectively, at the 12-month visit. At the 12-month visit, the efficacy index was 1.20 and the safety index was 1.39. Mean ECD was 2713 ± 339 cells/mm2at the preoperative visit and 2608 ± 362 cells/mm2at the 12-month visit (3.9% loss,p<0.001). ECD loss from 3 months to 12 months was not statistically significant. No significant cataract formation, significant endothelial cell loss, glaucoma, uveitis, or any other vision-threatening complication was observed.Conclusion. Based on postoperative experience, we have found that Eyecryl Phakic IOL is safe and effective for treating high myopia.

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