Clinical outcome of diffractive multifocal lens versus monofocal lens in post-laser in situ keratomileusis patients: A retrospective, comparative study

Purpose: To compare the clinical outcomes of diffractive multifocal and monofocal lenses in post?laser in situ keratomileusis (LASIK) patients who underwent cataract surgery. Methods: This was a retrospective, comparative study of clinical outcomes that was conducted at a referral medical center. Post?LASIK patients who underwent uncomplicated cataract surgery and received either diffractive multifocal or monofocal lens were studied. Visual acuities were compared at baseline and postoperatively. The intraocular lens (IOL) power was calculated with Barrett True?K Formula only. Results: At baseline, both groups had comparable age, gender, and an equal distribution hyperopic and myopic LASIK. A significantly higher percentage of patients receiving diffractive lenses achieved uncorrected distance visual acuity (UCDVA) of 20/25 or better (80 of 93 eyes, 86% vs. 36 of 82 eyes, 43.9%, P = 1.0 x 105) and uncorrected near vision of J1 or better (63% vs. 0) compared to the monofocal group. The residual refractive error had no significant difference (0.37 ± 0.39 vs. 0.44 ± 0.39, respectively, P = 0.16) in these two groups. However, more eyes in the diffractive group achieved UCDVA of 20/25 or better with residual refractive error of 0.25–0.5 D (36 of 42 eyes, 86% vs. 15 of 24 eyes, 63%, P = 0.032) or 0.75–1.5 D (15 of 21 eyes, 23% vs. 0 of 22 eyes, P = 1.0 x 10?5) compared to the monofocal group. Conclusion: This pilot study shows that patients with a history of LASIK who undergo cataract surgery with a diffractive multifocal lens are not inferior to those who receive monofocal lens. Post?LASIK patients with diffractive lens are more likely to achieve not only excellent near vision, but also potentially better UCDVA, regardless of the residual refractive error.

Evaluation of the retinal imaging quality of two kinds of diffractive multifocal intraocular lens by using two-channel technique / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the retinal image of two types of aspheric diffractive multifocal intraocular lens(IOL).<p>METHODS: Retrospective cohort study. Totally 155 cases of simple cataract who received phacoemulsification combined with IOLs implantation from October 2017 to October 2019. They were divided into three groups according to the types of IOL: Aspheric Bifocal Diffractive Group: 54 patients(54 eyes); Aspheric Trifocal Diffractive Group: 54 patients(54 eyes); Aspheric Monofocal Group: 47 patients(47 eyes). All patients were evaluated postoperatively at 6mo. Double-pass visual quality analysis system was used to evaluate OSI, MTF cutoff, Strehl Ratio, OV 100%, OV 20% and OV 9% respectively. Uncorrected distance visual acuity(5m), uncorrected intermediate visual acuity(80cm), uncorrected near visual acuity(40cm), corrected distance visual acuity, distance-corrected intermediate visual acuity, distance-corrected near visual acuity were measured and compared among three groups. Visual function-14 was also assessed.<p>RESULTS:Both of bifocal and trifocal groups had similar MTF cutoff(<i>P</i>=0.445), OV 100%, OV 20% and OV 9%(OV 100%: <i>P</i>=0.974; OV20%: <i>P</i>=0.713; OV 9%: <i>P</i>=0.947). Monofocal group had better MTF cutoff(<i>P</i>=0.007), OV 100%(<i>P</i>=0.001), OV 20%(<i>P</i>=0.002)and OV 9%(<i>P</i>=0.011)than bifocal. Besides, monofocal group had better MTF cutoff(<i>P</i>=0.043), OV 100%(<i>P</i>=0.012), OV 20%(<i>P</i>=0.043)and OV 9%(<i>P</i>=0.029)than trifocal group. There was no difference among all groups in uncorrected distance visual acuity and corrected distance visual acuity(<i>P</i>=0.054, 0.180). There was difference in distance-corrected intermediate(<i>H</i>=91.292, <i>P</i><0.01)and distance-corrected near visual acuity(<i>H</i>=91.292, <i>P</i><0.01). Uncorrected intermediate visual acuity was better in trifocal group than bifocal(<i>P</i><0.01)and monofocal group(<i>P</i><0.01). Distance-corrected intermediate visual acuity was better in trifocal group than bifocal(<i>P</i><0.01)and monofocal group(<i>P</i><0.01). Both of bifocal and trifocal groups have similar uncorrected near visual acuity(<i>P</i>=0.428)and distance-corrected near visual acuity(<i>P</i>=0.519), which was better than monofocal group(<i>P</i><0.01). In terms of VF-14, score in bifocal and trifocal groups are significantly higher than the monofocal group(<i>P</i><0.01). There was no difference in bifocal and trifocal groups(<i>P</i>=0.055).<p>CONCLUSION: Bfocal and trifocal diffractive IOL can provide similar retinal image. Trifocal IOL can provide better itermediate visual acuity.

Effect of different types of intraocular lens implantation on visual quality after cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the visual quality and visual related quality of life in cataract patients after implantation of diffractive aspheric bifocal IOL and single focus aspheric IOL. <p>METHODS: Retrospective non-randomized study was implemented. In clinical application 110 patients(176 eyes)underwent phacoemulsification combined with IOL from October 2016 to December 2017. In details, 56 cases(82 eyes)with diffractive aspheric bifocal IOL(ZEISS AT LISE 809M)and 54 cases(94 eyes)with single focus aspheric IOL(ZEISS CTA 603P), respectively. Three months after surgeries, the main evaluation indices were successively collected, which included visual, the optical quality analysis system(OQAS)of the MTF cutoff, the Strehl ratio, the OSI, the 100% visual acuity(VA), the 20% VA and the 9% VA, as well as the visual function related quality of life scale(NEI-VFQ-25).<p>RESULTS: 1)VA: there was no significant difference in the corrected distance visual acuity(CDVA)between the two groups(<i>P</i>>0.05). However, there existed significant difference in the near vision(<i>P</i><0.05); 2)Objective quality visual analysis(OQAS): there was significant difference in the OSI. Regarding the visual acuity of simulated contrast sensitivity between two groups, the 20% VA and 9% VA expressed significant difference(<i>P</i><0.01); 3)NEI-VFQ-25 questionnaire: there were no significant differences in overall health, general vision, eye pain, distant vision, peripheral vision, social function, color vision, dependence and mental health between the two groups(<i>P</i>=0.88, 0.08, 0.60, 0.36, 0.80, 0.18, 0.41, 0.07, 0.95). But there was significant difference in near vision and social role limitation between the two groups(<i>P</i><0.05).<p>CONCLUSION: The 809M intraocular lenses and the 603P intraocular lenses can improve the optical quality of patients after the surgeries. The former one can provide better near vision, but the OSI was higher than the latter one, which may cause some visual interference. There was no significant difference in visual related quality of life after the surgeries generally.

Therapeutic effects of phacoemulsification respectively combined with diffractive multifocal IOL and monofocal IOL implantation in the treatment of cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the therapeutic effects of phacoemulsification respectively combined with diffractive multifocal intraocular lens(IOL)and monofocal IOL implantation in the treatment of cataract. <p>METHODS: A total of 99 cataract patients(145 eyes)who underwent phacoemulsification combined with IOL implantation in the hospital from January 2015 to February 2019 were divided into observation group(<i>n</i>=51, 75 eyes)and control group(<i>n</i>=48, 70 eyes)according to the non-randomized clinical trial and patient voluntary principles. The observation group was treated with diffractive multifocal IOL implantation, while the control group was treated with monofocal IOL implantation. The visual acuity, corneal endothelial cell count, loss rate of corneal endothelial cells, results of corneal topography, and contrast sensitivity(CS)in daytime, day glare time, nighttime and night glare time were compared between two groups. The complications and spectacles-independent rate were counted. <p>RESULTS: At 1wk, 1mo and 3mo, there were no significant differences in the best corrected distance visual acuity(BCDVA)and best corrected near visual acuity(BCNVA)between two groups(<i>P</i>>0.05). However, the uncorrected distance visual acuity(UCDVA)at 1wk and 1mo, the uncorrected near visual acuity(UCNVA)and the distance corrected near visual acuity(DCNVA)at 1wk, 1mo and 3mo of the observation group were significantly lower than those of the control group(<i>P</i><0.05). After surgery, corneal endothelial cell counts and astigmatism of two groups decreased significantly. No significant differences were found in corneal endothelial cell count, loss rate of corneal cells and astigmatism between two groups(<i>P</i>>0.05). CS in daytime of 1.5c/d frequency band, in day glare time of 1.5c/d, 3c/d and 6c/d frequency bands, in nighttime of 3c/d and 18c/d frequency bands, in night glare time of 3c/d, 6c/d and 18 c/d frequency bands were significantly lower, while CS in daytime of 12c/d frequency band was significantly higher in the observation group than in the control group. There was no significant difference in the incidence of complications between two groups(<i>P<</i>0.05), but the spectacles-independent rate was significantly higher in the observation group than in the control group(<i>P</i><0.05). <p>CONCLUSION: Phacoemulsification combined with diffractive multifocal IOL implantation can obtain good total range visual acuity, with a higher spectacles-independent rate and relatively low CS after surgery.

Resultados clínicos con la lente intraocular trifocal Acriva Trinova / Clinical results obtained with the Acriva Trinova trifocal intraocular lens

RESUMEN Objetivo: Describir los resultados clínicos obtenidos con la lente trifocal Acriva Trinova. Métodos: Se realizó un estudio observacional, descriptivo, longitudinal y prospectivo donde se describieron los resultados visuales en 6 pacientes (12 ojos) operados del cristalino con la técnica de facochop e implante de lente intraocular trifocal modelo Acriva Trinova, en el Instituto Cubano de Oftalmología Ramón Pando Ferrer en noviembre del año 2017. Se analizaron variables como: edad, sexo, agudeza visual sin y con corrección a diferentes distancias, equivalente esférico, sensibilidad al contraste, síntomas disfotópticos y estado de satisfacción subjetiva de pacientes operados. Resultados: La edad media fue 54,5 años y la mayoría de los ojos (91,7 por ciento) eran portadores de un componente esférico hipermetrópico. Se constató una recuperación posoperatoria de la agudeza visual de lejos monocular sin corrección con una media de 0,90. En visión binocular sin corrección se alcanzó una mejoría tanto de la visión intermedia (la mitad de los pacientes lograron leer un J1), así como de la visión de cerca (83,3 por ciento logró leer un J2 o mejor). El equivalente esférico medio posoperatorio fue de 0,38 D ± 0,29. En este trabajo la totalidad de los pacientes se manifestaron satisfechos con sus resultados visuales, y en cuanto a la sensibilidad al contraste con esta lente se obtuvieron resultados compatibles con criterios de normalidad. Conclusiones: El implante de esta lente trifocal disminuye la dependencia de las gafas después de la cirugía del cristalino y mejora la calidad de vida en estos pacientes(AU)

ABSTRACT Objective: Describe the clinical results obtained with the Acriva Trinova trifocal lens. Methods: An observational descriptive longitudinal prospective study was conducted of the visual results of 6 patients (12 eyes) undergoing crystalline lens surgery by phaco-chop technique and implantation of a trifocal intraocular lens model Acriva Trinova at Ramón Pando Ferrer Cuban Institute of Ophthalmology in November 2017. The variables analyzed were age, sex, visual acuity with and without correction at various distances, spherical equivalent, contrast sensitivity, dysphotopsia symptoms and patient satisfaction. Results: Mean age was 54.5 years and most eyes (91.7 percent) had a hyperopic spherical component. Postoperative recovery was observed of far monocular visual acuity without correction with a mean of 0.90. In binocular vision without correction improvement was achieved of both intermediate vision (half the patients were able to read a J1) and near vision (83.3 percent were able to read a J2 or better). Mean postoperative spherical equivalent was 0.38 D ± 0.29. All the patients in the study expressed satisfaction with their visual results. The contrast sensitivity results obtained with the lens met normality criteria. Conclusions: Implantation of this trifocal lens reduces dependence on eyeglasses after crystalline lens surgery and improves the quality of life of patients(AU)

Trifocal versus Bifocal Diffractive Intraocular Lens Implantation after Cataract Surgery or Refractive Lens Exchange: a Meta-analysis

BACKGROUND: We compared the efficacy between trifocal and bifocal diffractive intraocular lens (IOL) implantation. METHODS: Through PubMed, MEDLINE, EMBASE, and CENTRAL, we searched potentially relevant articles published from 1990 to 2018. Defocus curves, visual acuities (VAs) were measured as primary outcomes. Spectacle dependence, postoperative refraction, contrast sensitivity (CS), glare, and higher-order aberrations (HOAs) were measured as secondary outcomes. Effects were pooled using random-effects method. RESULTS: We included 11 clinical trials, with a total of 787 eyes (395 subjects). The trifocal IOL group showed better binocular distance VA corrected with defocus levels of −0.5, −1.0, −1.5, and −2.5 diopter than the bifocal IOL group (All P ≤ 0.004). The trifocal IOL group showed better monocular uncorrected distance and intermediate VAs (mean difference [MD], −0.04 logarithm of the minimum angle of resolution [logMAR]; 95% confidence interval [CI], −0.07, −0.01; P = 0.006 and MD, −0.07 logMAR; 95% CI, −0.13, −0.01; P = 0.03, respectively). Postoperative refraction, glare, CS, and HOAs were not significantly different from each other. CONCLUSION: The overall findings indicate that trifocal diffractive IOL implantation is better than the bifocal diffractive IOL in intermediate VA, and provides similar or better in distance and near VAs without any major deterioration in the visual quality.

Comparison of the Visual Outcomes after Cataract Surgery with Implantation of a Bifocal and Trifocal Diffractive Intraocular Lens

PURPOSE: To evaluate and compare visual outcomes and optical quality after implantation of a bifocal (Acrysof ReSTOR® SN6AD1) or trifocal (AT LISA® tri 839MP) diffractive intraocular lens (IOL). METHODS: Fifty-one eyes of 43 patients undergoing cataract surgery were enrolled and assigned to one of two groups: the trifocal group, comprising 24 eyes implanted with the trifocal diffractive IOL (AT LISA® tri 839MP), and the bifocal group, comprising 27 eyes implanted with the bifocal diffractive IOL (Acrysof ReSTOR® SN6AD1). Visual acuity (distant, intermediate, and near vision) and refractive postoperative outcomes were evaluated at one and three months postoperatively. Measurements of optical quality (using OQAS II®), contrast sensitivity (using CGT-2000®), automated visual field examination, and evaluation of defocus curve were performed three months postoperatively. RESULTS: No statistically significant differences between the two groups were found in three-month postoperative distant and near (40 cm) visual acuities and optical quality. However, intermediate (63 cm, 80 cm, and 100 cm) visual acuities were significantly better in the trifocal group. Distant contrast sensitivity (5 m) under mesopic conditions was significantly better with the bifocal lens, whereas near contrast sensitivity (30 cm) under mesopic and scotopic conditions was significantly better with trifocal lens. There was no statistical difference between the groups under photopic conditions. In the defocus curve, the visual acuity was significantly better at intermediate distance in the trifocal group. CONCLUSIONS: Trifocal diffractive IOLs provide significantly better intermediate vision than bifocal IOLs, with equivalent postoperative levels of distant and near vision and ocular optical quality. Further, they provide better near contrast sensitivity under scotopic condition compared to diffractive bifocal IOLs.

Comparison of Clinical Outcomes between Diffractive and Refractive Multifocal Intraocular Lens with Same Near Added

PURPOSE: To compare the clinical outcomes between refractive-type multifocal intraocular lenses (IOL) (Lentis Mplus(R) LS 313, Oculentis GmbH., Berlin, Germany) and diffractive-type multifocal IOL (Acrysof Restor(R); SN6AD1, Alcon Lab., Fort Worth, TX, USA) with same near added. METHODS: We evaluated 30 eyes implanted with Lentis Mplus(R) IOL and 33 eyes implanted with Acrysof Restor(R) IOL after phacoemulsification. The distant, intermediate, and near uncorrected visual acuities of the 2 groups were evaluated at 2 weeks and 1, 3, and 6 months postoperatively. Optical quality obtained using the Optical Quality Analysis System II (OQAS II(R), Visiometrics, Castelldefels, Barcelona, Spain), higher-order aberrations (HOAs), and patient satisfaction questionnaire of the 2 groups were evaluated at 3 months postoperatively. RESULTS: The visual acuity of intermediate 100 cm was statistically better in the Lentis Mplus(R) group (p < 0.05). There were no significant differences between the 2 groups with distant, intermediate 63 cm, and near vision. At the 3-month postoperative follow-up, objective scatter index, modulation transfer function (MTF) cutoff value, and pseudo-accommodation range measured by OQAS II(R) showed no differences between the 2 groups, but Strhel ratio was higher in the Acrysof Restor(R) group. HOAs of 5 mm and 6 mm increased significantly in the Lentis Mplus(R) group. No significant differences were found in the patient satisfaction questionnaire. CONCLUSIONS: Both refractive and diffractive-type multifocal IOL implantation in patients with cataracts and presbyopia offered good and comparable visual acuity at distance and near. However, the Lentis Mplus(R) IOL provided better intermediate vision than the Acrysof Restor(R) IOL.

Clinical Outcomes of Diffractive Trifocal Intraocular Lens in Both Eyes: A 6-Month Follow-Up

PURPOSE: To evaluate clinical outcomes after cataract surgery with bilateral implantation of the diffractive trifocal intraocular lens (IOL). METHODS: Forty-four eyes of 22 patients were analyzed in the present study from July 2014 to December 2014. Phacoemulsification with bilateral implantation of an AT Lisa tri 839 MP IOL (Carl Zeiss Meditec, Jena, Germany) was performed. Over a 6-month follow-up, the main outcome measures were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 80 cm, uncorrected near visual acuity (UNVA) at 40 cm, and spherical equivalent refraction. Visual quality and patient satisfaction were evaluated using a Quality of Vision questionnaire. Finally, the defocus curve was measured. RESULTS: The mean monocular UNVA, UIVA, and UDVA were 0.23, 0.22, and 0.02 log MAR at 1 month, 0.21, 0.20, and 0.01 log MAR at 3 months and 0.20, 0.22, and 0.01 log MAR at 6 months postoperatively, respectively. The mean binocular UNVA, UIVA, and UDVA were 0.16, 0.12, and 0.0 log MAR at 1 month, 0.15, 0.11, and 0.0 log MAR at 3 months and 0.15, 0.13, and 0.0 log MAR at 6 months postoperatively, respectively. Twelve patients reported glare and 17 patients reported halo. Defocus curve showed best visual acuity results at 0.0 D and second peak at - 2.5 D. The intermediate-vision values were stable. CONCLUSIONS: Diffractive trifocal IOL provided excellent distance, intermediate, and near visual outcomes.

Resultados visuales con nuevo lente trifocal AT LISA® tri 839MP: serie de casos / Visual outcomes with new lens trifocal AT LISA® tri 839MP: case series

Objetivo: Evaluar los resultados visuales del implante de lente trifocal AT LISA® tri 839MP en pacientes con cataratas o presbicia. Métodos: reporte de serie de casos de 14 pacientes (24 ojos) en los que se realizó facoemulsificacion del cristalino e implante del lente trifocal AT LISA® tri 839MP. Resultado: en un periodo promedio de 6,3 meses se evaluó la visión la cercana y lejana con promedios de visión logMar sin corrección de 0,004 y 0,008 respectivamente y para la visión intermedia el promedio logMar fue 0,02; con 100% de los pacientes con independencia de gafas Los fenómenos visuales como halos estuvieron presentes en 8,4% de los ojos. Conclusiones: el lente evaluado produce excelentes resultados visuales en función visual lejos, intermedia y cerca con gran satisfacción del paciente.

Objective: to evaluate visual results in trifocal lens implant AT LISA tri 839MP® in patients with cataracts and presbyopia. Methods: this case series report comprised 14 patients (24 eyes) who had lens phacoemulsification and implantation of AT LISA tri 839MP® trifocal lens. Results: during an average period of 6.3 months, mean values of 0,004 and 0,008 logMar were obtained respectively for uncorrected near and distance vision and the average intermediate vision was assessed with logMAR scale at 0,02 ;100% of patients have independence of spectacles. Visual phenomena as halos were presented in 8.4 % of eyes. Conclusions: the evaluated lens produces excellent visual results in far, intermediate and near visual acuity, with great patient satisfaction.

Clinical Outcomes of M-Plus Intraocular Lenses

PURPOSE: To evaluate the clinical outcomes of eyes implanted with a zonal refractive multifocal intraocular lens (IOL) with an inferior segmental near add (M-plus), and to compare the outcomes between M-plus and a diffractive-type multifocal IOL, AT LISA (366D, bifocal). METHODS: We reviewed 19 eyes from 10 patients who were implanted with M-plus and 52 eyes of 26 patients who were implanted with AT LISA. The clinical outcomes of these 2 intraocular lenses were evaluated at 1 day and 2 months postoperatively, and consisted of distant, intermediate, and near visual acuity, contrast sensitivity, degree of tilt, and decentration using anterior segment photography, depth of focus, and patient satisfaction. RESULTS: There were no statistical differences between the 2 groups with respect to distant vision, near vision, refractive error, contrast sensitivity, degree of tilt, decentration, or satisfaction score. The M-plus group demonstrated significantly better intermediate visual acuity. In the defocus curve, the M-plus group also demonstrated significantly better visual acuities for intermediate unfocused vision levels. CONCLUSIONS: The M-plus multifocal IOLs are able to provide satisfactory distant and near visual acuity and visual function. The M-plus multifocal IOLs provide better intermediate vision than the AT LISA.

Clinical Results and Optical Quality of Diffractive Multifocal IOL Implantation after Myopic Refractive Surgery

PURPOSE: To evaluate the visual outcome and optical quality in eyes with diffractive multifocal intraocular lens (DMIOL) implantation after myopic refractive surgery. METHODS: Nineteen eyes (15 patients) were implanted with AcriSof ReSTOR(R) SN6AD1, the aspheric DMIOL after myopic refractive surgery (laser-assisted in situ keratomileusis [LASIK] 14 eyes, photorefractive keratectomy [PRK] 4 eyes, laser-assisted subepithelial keratomileusis [LASEK] 1 eye). Preoperative and postoperative visual acuities and manifest refraction were measured. Preoperative corneal higher-order aberrations (HOAs) were measured using Hartmann-Shack (H-S) aberrometer in dilated pupils, and optical qualities were measured 1 month postoperatively using H-S aberrometer and a double-pass system under mesopic conditions. Patient satisfaction was investigated using a questionnaire at 2 months postoperatively. RESULTS: Uncorrected distant and near visual acuities at postoperative 2 months were 0.11 +/- 0.19, and 0.19 +/- 0.12 (log MAR), respectively. Postoperative spherical equivalent (SE) of 16 eyes (84.2%) was within +/-0.50 diopters (D) and all eyes were within +/-1.00 D from emmetropia. Preoperative corneal and postoperative ocular spherical aberrations in a 4.0 mm pupil diameter were 0.08 +/- 0.08 and 0.07 +/- 0.07 (microm), respectively. Objective scatter index was 3.42 +/- 1.71 and modulation transfer function (MTF) cut-off value was 21.03 +/- 12.37 cpd. General satisfaction score was 3.52 +/- 0.96 points out of 5, and 8 patients (11 eyes) were not satisfied with DMIOL implantation. CONCLUSIONS: After DMIOL implantation in the eyes with previous myopic refractive surgery, postoperative SE was close to the target D, but optical qualities and patient satisfaction were poor.

Clinical Results and Optical Quality of Diffractive Multifocal IOL Implantation after Myopic Refractive Surgery

PURPOSE: To evaluate the visual outcome and optical quality in eyes with diffractive multifocal intraocular lens (DMIOL) implantation after myopic refractive surgery. METHODS: Nineteen eyes (15 patients) were implanted with AcriSof ReSTOR(R) SN6AD1, the aspheric DMIOL after myopic refractive surgery (laser-assisted in situ keratomileusis [LASIK] 14 eyes, photorefractive keratectomy [PRK] 4 eyes, laser-assisted subepithelial keratomileusis [LASEK] 1 eye). Preoperative and postoperative visual acuities and manifest refraction were measured. Preoperative corneal higher-order aberrations (HOAs) were measured using Hartmann-Shack (H-S) aberrometer in dilated pupils, and optical qualities were measured 1 month postoperatively using H-S aberrometer and a double-pass system under mesopic conditions. Patient satisfaction was investigated using a questionnaire at 2 months postoperatively. RESULTS: Uncorrected distant and near visual acuities at postoperative 2 months were 0.11 +/- 0.19, and 0.19 +/- 0.12 (log MAR), respectively. Postoperative spherical equivalent (SE) of 16 eyes (84.2%) was within +/-0.50 diopters (D) and all eyes were within +/-1.00 D from emmetropia. Preoperative corneal and postoperative ocular spherical aberrations in a 4.0 mm pupil diameter were 0.08 +/- 0.08 and 0.07 +/- 0.07 (microm), respectively. Objective scatter index was 3.42 +/- 1.71 and modulation transfer function (MTF) cut-off value was 21.03 +/- 12.37 cpd. General satisfaction score was 3.52 +/- 0.96 points out of 5, and 8 patients (11 eyes) were not satisfied with DMIOL implantation. CONCLUSIONS: After DMIOL implantation in the eyes with previous myopic refractive surgery, postoperative SE was close to the target D, but optical qualities and patient satisfaction were poor.

Comparisons of Visual Acuity, Spherical Aberration and Contrast Sensitivity among Spheric, Aspheric ReSTOR(R), and Crystalens HD(R) Lenses

PURPOSE: To assess visual acuity, spherical aberration and contrast sensitivity in patients who were implanted with spheric, aspheric ReSTOR(R) or Crystalens HD(R) lenses. METHODS: The present study enrolled 16 patients (32 eyes) implanted with biliateral spheric ReSTOR(R) (four patients, spheric ReSTOR group), bilateral aspheric ReSTOR(R) (seven patients, aspheric ReSTOR group) or bilateral Crystalens HD(R) (five patients, Crystalens HD group) lenses. At three months postoperatively, visual acuity, spherical aberration, and contrast sensitivity were evaluated. RESULTS: Three months after surgery, there were no significant differences in uncorrected distant or intermediate visual acuity among the three groups. Uncorrected near visual acuity in the spheric and aspheric ReSTOR groups was superior to that in the Crystalens HD group, and the aspheric ReSTOR group had less spherical aberration. Mesopic contrast sensitivity in the Crystalens HD group was significantly higher at three cycles per degree compared to those in the spheric and aspheric ReSTOR groups. CONCLUSIONS: Uncorrected near visual acuity in the Crystalens HD group was inferior to those in the spheric and aspheric ReSTOR groups, but the mesopic contrast sensitivity of the Crystalens HD group at three cycles per degree was superior to those in the spheric and aspheric ReSTOR groups.

Comparison of Wavefront Analysis and Visual Function Between Monofocal and Multifocal Aspheric Intraocular Lenses

PURPOSE: To compare postoperative vision, high-order aberrations, contrast sensitivity, power of accommodation, and depth of focus of monofocal aspheric (TECNIS ZA9003) and multifocal aspheric (TECNIS ZM900) intraocular lenses (IOL). METHODS: Thirty-four eyes which received intraocular lens implantation in the posterior chamber were equally divided into two groups: TECNIS ZA9003 (17 eyes) and TECNIS ZM900 (17 eyes). Before and three months after surgery, visual acuities at near, intermediate, and far distances, and depth of focus were recorded. High order aberrations, spherical aberrations and accommodation power were measured with iTrace, and contrast sensitivity was evaluated using Optec 6500. An independent T-test analysis was used to compare the two groups. RESULTS: There were no significant differences of high order aberrations, spherical aberrations, accommodation power, or distance vision between the two groups at three months postoperatively. The multifocal IOL (TECNIS ZM900) group revealed better intermediate and near vision (p<0.01) and deeper depth of focus, and lower contrast sensitivities (p=0.03) than the monofocal IOL group. CONCLUSIONS: There was no difference in accommodation power between the two groups, but multifocal TECNIS ZM900 IOL exceeds monofocal TECNIS ZA9003 IOL in intermediate and near vision due to diffractive lens design and less spherical aberration by its asphericity.

Clinical Results and Some Problems of Multifocal Apodized Diffractive Intraocular Lens Implantation

PURPOSE: To evaluate near and far visual outcomes, subjective visual symptoms, and patient satisfaction with AcrySof(R) ReSTOR(R) diffractive multifocal intraocular lenses (IOL), and to study the reasons for postoperative dissatisfaction. METHODS: Twenty-three eyes of 19 patients received phacoemulsifications and implantation of AcrySof(R) ReSTOR(R) IOL. The main outcome measures, taken at postoperative 1 day, 1 week, 1 month, and 3 months, were uncorrected and corrected near and distant visual acuity, refractory errors, subjective visual symptoms (glare, halo, and night vision), and satisfaction. RESULTS: At the 3-month postoperative visit, the mean uncorrected near and distant visual acuities were 0.59+/-0.24 (0.25+/-0.22 LogMAR unit) and 0.78+/-0.27 (0.13+/-0.10 LogMAR unit), respectively. In addition, patients' satisfaction with uncorrected near vision, intermediate vision, far vision, and general visual performance were better than their satisfaction with night vision. Glare and halos were reported as severe by only 10.2% and 5.3% of patients, respectively. The seven eyes with poor patient satisfaction included eyes with a high incidence of preoperative ocular diseases or preoperative and postoperative high corneal astigmatisms of more than 1.0 diopter. CONCLUSIONS: The AcrySof(R) ReSTOR(R) IOL demonstrated good near and distant visual acuity with good patient satisfaction. Previous ocular disease, corneal astigmatism less than 1.0 diopter, and patient lifestyle should be considered to enhance patient satisfaction.

Pseudoaccomodation in Pseudophakic Eyes with 3M Multifocal Intraocular Lens

We measured the near point of accommodation in 59 patients (59 eyes), who were implanted with 3M diffractive multifocal intraocular lens, in order to evaluote the pseudoaccommodation Average amount of pseudoaccommodation were 3.65 diopter (standard deviation was 1.75) and it was greater than that of monofocal intraocular lens Far vision and age did not affect the pseudoaccommodation. Near visual acuity alone appeared to have a positive correlation with pseudoaccommodation.

Clinical Results of 3M Multifocal Intraocular Lens

We followed up the 100 patients (104 eyes) who had undergone cataract extraction and PCL implantation into the bag with 3M diffractive multifocal intraocular lensee for at least 2 month, in order to evaluate the function of this lens. 92 eyes (88.5%) had the far corrected vision more than 0.5 and 94 eyes (90.4%) had the near vision with far correction more than J3. We added additional adds (-0.25, +0.25, +0.50, +0.75D) in order to ascertain the adequacy of +3.50D add in this lens and it was found that the additional add of +0.75D was most preferred. This means that more add is necessary for near vision. There was, also, no more remarkable side effects or difficulties associated with this lenses. So, multifocal Intraocular lenses enable good near vision without any severe disadvatages but the amount of near add is cuntroversial.