Rethinking presbyopia: results of bilateral refractive lens exchange with trifocal intraocular lenses in 17 603 patients.

PURPOSE: To evaluate the safety and effectiveness of bilateral refractive lens exchange (RLE) with trifocal intraocular lens (IOL) as the surgical treatment of presbyopia. SETTINGS: Memira AS. Norway, Sweden and Denmark. DESIGN: Multicentric retrospective interventional case series. METHODS: 17 603 consecutive patients submitted to bilateral presbyopic RLE with trifocal IOLs from 2013 to 2019. The main outcomes were manifest refraction spherical equivalent (MRSE), uncorrected distance (UDVA) and near (UNVA) visual acuity, corrected distance visual acuity (CDVA), vision gain/loss, safety and efficacy indices, IOL power calculation accuracy and rate of excimer laser enhancements. RESULTS: Three months postoperatively, the mean MRSE was 0.00±0.40 diopters (D), mean binocular UDVA was -0.03±0.09, with 14 470 patients (82.2%) with combined binocular UDVA and UNVA equal or better than 0.00 and Jaeger 3. Approximately 86% (n=30.124) of the eyes were within 0.50D of MRSE. Enhancement surgery was performed in 5810 eyes (16.5%). IOL power calculation refining improved accuracy and reduced enhancements rate from 20% in 2013 to 12% in 2019. Safety and efficacy indices were 0.98±0.11 and 0.85±0.18, respectively. Myopic eyes presented significant higher safety (1.00±0.19) and efficacy indices (0.87±0.19), with p<0.005. Approximately 0.38% (n=130) of the eyes lost two or more lines of CDVA, with cystoid macular oedema (n=53, 40.8%) and posterior capsular opacification (n=35, 26.9%) as the main causes. After proper care, the final incidence of two or more lines of vision loss was 0.08% (28 eyes). CONCLUSIONS: Presbyopic RLE with trifocal IOL is a safe and effective modality of treatment for patients with presbyopia.

Presbyopic refractive lens exchange with trifocal intraocular lens implantation after corneal laser vision correction: Refractive results and biometry analysis.

PURPOSE: To evaluate the refractive and biometry results of presbyopic refractive lens exchange (RLE) with trifocal intraocular lens (IOL) implantation in eyes with previous myopic or hyperopic corneal laser vision correction (LVC). SETTINGS: Memira AS, Norway, Sweden, and Denmark. DESIGN: Retrospective case series. METHODS: The refractive results included the manifest refraction spherical equivalent, uncorrected near (UNVA) and distance (UDVA) visual acuities, corrected distance visual acuity, safety, efficacy, and precision. The biometry analysis included the refractive prediction error (RPE), median absolute error (MedAE), and percentage of eyes within a certain RPE range for the formulas from the American Society of Cataract and Refractive Surgery (ASCRS) online calculator. RESULTS: The study comprised 241 eyes. Six months postoperatively, 60.0% of eyes were within ±0.25 diopter (D), 80.9% within ±0.50 D, and 97.9% within ±1.00 D of emmetropia. There were no statistical differences in the mean monocular UDVA (0.87 ± 0.20 [SD]), safety index (0.98 ± 0.09), or efficacy index (0.81 ± 0.18) between the myopic ablation group and hyperopic ablation group. Binocularly, 85% of patients had simultaneous UDVA and UNVA of 0.9 or better and Jaeger 3, respectively. The ASCRS online calculator formulas gave different performances for previous myopic and hyperopic ablation profiles. Using optimized constants and nomogram for correcting the mean RPE improved the MedAE. CONCLUSIONS: Presbyopic RLE was safe and effective in selected cases with a history of LVC. The use of optimized IOL constants and nomograms can improve the refractive precision of lens-based refractive surgery.

The Use of Capsular Tension Rings to Reduce Refractive Shift in Patients With Implantation of Trifocal Intraocular Lenses.

PURPOSE: To determine whether use of a capsular tension ring (CTR) can increase refractive stability in patients with implantation of two different trifocal intraocular lenses (IOLs). METHODS: A prospective, consecutive series of eyes underwent refractive lens exchange with implantation of two different trifocal IOL designs: FineVision Micro F (non-toric) and FineVision POD FT (toric) (PhysIOL, Liege, Belgium). Power calculation was determined using the Haigis formula. Refractive lens exchange surgery was performed according to the standard Memira protocol. Refractive results and stability were assessed at 2 weeks and 3 months postoperatively. RESULTS: Three hundred eighty-eight eyes were included in the analysis. Overall, 71% and 76% of MicroF eyes implanted with (n = 139) and without (n = 104) a CTR, respectively, had hyperopic shift; 9% of MicroF eyes with a CTR had a shift of greater than +0.50 to +0.75 or less diopters (D) and 4% had a shift of greater than +0.75 D. In MicroF eyes without a CTR, 12% and 3% of eyes experienced a refractive shift of greater than +0.50 to +0.75 D or less and greater than +0.75 D, respectively. In the POD FT group, 72% and 69% of eyes with (n = 81) and without (n = 64) a CTR, respectively, had hyperopic shift; 10% of POD FT eyes with a CTR had a change of greater than +0.50 to +0.75 D or less and 7% had a shift of greater than +0.75 D. In POD FT eyes without a CTR, 13% and 3% experienced a refractive shift of greater than +0.50 to +0.75 D or less and greater than +0.75 D, respectively. For the MicroF design, the best refractive stability was found in the CTR group and the poorest stability in the non-CTR group (P = .084). For the POD FT design, the best refractive stability was found in the non-CTR group and the poorest stability in the CTR group (P = .297). CONCLUSIONS: Up to 7% of eyes implanted with FineVision trifocal IOLs had a hyperopic shift of greater than +0.75 D approximately 2 weeks to 3 months postoperatively. Using a CTR in MicroF eyes had no statistically significant effect on refractive stability. Placing a CTR with POD FT IOLs appeared to reduce refractive stability, although not significantly. [J Refract Surg. 2017;33(12):802-806.].