Multifocal intraocular lenses in the setting of glaucoma.

PURPOSE OF REVIEW: The purpose of this review is to collate evidence and make recommendations regarding the use of multifocal intraocular lenses in patients with glaucoma. RECENT FINDINGS: Multifocal intraocular implants have been in use since the 1980s. Several studies have been done comparing their advantages and disadvantages compared with conventional monofocal intraocular implants. Most of these studies have looked at patients with cataract and no ocular comorbities. Reports of their use in eyes with concurrent disease are scarce. We review the available evidence and the potential benefits and pitfalls of using multifocal intraocular lenses in glaucomatous eyes. A recently published Cochrane review identified eight trials which had stringent criteria to recruit patients. These studies excluded all patients with concurrent eye diseases. No recent publications are available specifically evaluating the use of multifocal intraocular lenses in patients with glaucoma. SUMMARY: Firm recommendations cannot be made on the use of multifocal intraocular lenses in patients with glaucoma as large studies have not been done to evaluate their benefit. Currently, the decision of whether to use multifocal intraocular lenses in patients with glaucoma has to be made on an individual basis.

Outcomes of sulcus implantation of Array multifocal intraocular lenses in second-eye cataract surgery complicated by vitreous loss.

PURPOSE: To evaluate the outcomes of implantation of the Array((R)) multifocal intraocular lens (IOL) (model SA-40N, AMO) in the ciliary sulcus in second-eye cataract surgery complicated by vitreous loss. SETTING: Department of Ophthalmology, Arrowe Park Hospital, Wirral, United Kingdom. METHODS: This retrospective study comprised 15 patients who had complicated second-eye cataract surgery with loss of posterior capsule support leading to sulcus implantation of an Array multifocal IOL. The patients were recalled for assessment. Objective evaluation included uncorrected and corrected distance and near visual acuities, complications, and IOL centration. Subjective assessment was performed using a questionnaire that included the VF-14 index of visual function; the questions were related to satisfaction with vision, limitations from halos and glare, and the frequency of spectacle wear. RESULTS: Fourteen eyes (93%) had postoperative visual improvement. The best corrected distance acuity was 6/12 or better in 11 eyes (73%). The best corrected near acuity was J2 or better in 12 eyes (80%). The IOL was well centered in 11 eyes (73%) and slightly decentered in 4 eyes (27%). Subjectively, patients indicated a high level of satisfaction with their distance and near vision. The VF-14 indicated high levels of visual function, with 73% of patients having a score higher than 90 (out of 100). Seventy-three percent of patients were not troubled by glare or halos, and 40% did not wear spectacles. CONCLUSION: Implantation of the Array multifocal IOL in the sulcus during complicated phacoemulsification led to good visual outcomes based on objective and subjective patient measures.