Trifocal intraocular lenses have good outcomes even after previous photorefractive surgery

Recent advances in microsurgery and the latest developments in intraocular lenses (IOLs) have allowed surgeons to achieve more accurate and predictable postoperative refractive results. In recent years, the range of multifocal lenses has increased significantly. These were developed to contain more than one lens power in order to provide a wider range of clear vision that is, at distance, intermediate and near vision.

A retrospective study by Cobo-Soriano and team revealed that Trifocal IOL implantation after photorefractive surgery in eyes which was previously treated with myopic ablation achieved good visual outcomes but less predictability in the high myopia subgroup. Eyes with a previous hyperopic corneal ablation achieved excellent precision but worse visual and safety outcomes in the high hyperopia subgroup.

The findings of the study are published in Journal of Cataract & Refractive Surgery.

The objective of the study was to evaluate the visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes previously treated with myopic and hyperopic corneal refractive laser surgery.

The study was Retrospective comparative case series. The series was divided into 2 groups according to the type of corneal laser refraction (myopic and hyperopic). The main visual and refractive outcome measures included corrected distance visual acuity (CDVA) and uncorrected distance and near visual acuity, safety, efficacy, and predictability. The secondary outcome measures were percentage of enhancement and Nd:YAG capsulotomy and influence of prelaser magnitude of myopia and hyperopia on the outcome of trifocal IOL implantation.

The results of the study were

• The sample included 868 eyes (543 patients): myopic, n = 319 eyes (36.7%); and hyperopic, n = 549 eyes (63.2%).

• Three months postoperatively, visual outcomes were poorer in the hyperopic group than those in the myopic group for mean CDVA (0.06 ± 0.05 vs 0.04 ± 0.04, P < .01) and safety (21% vs 12% of CDVA line loss, P < .05) outcomes.

• However, precision outcomes were worse in the myopic group than those in the hyperopic group, with a mean spherical equivalent of −0.38 ± 0.3 vs −0.17 ± 0.3 (P < .01).

• Stratification by magnitude of primary laser treatment revealed poorer visual and safety results in the high hyperopia subgroup (>+3.0 diopters [D]) and poorer precision in the high myopia subgroup (<−5.0 D).

Soriano and team concluded that "Trifocal IOL implantation after photorefractive surgery in eyes previously treated with myopic ablation achieved good visual outcomes but less predictability in the high myopia subgroup. However, eyes with a previous hyperopic corneal ablation achieved excellent precision but worse visual and safety outcomes in the high hyperopia subgroup."

Reference: doi: 10.1097/j.jcrs.0000000000000637