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Purpose: To evaluate and compare the effect of decentration and tilt on the optical quality of monofocal and trifocal intraocular lenses (IOL)., Methods: Optical quality of a monofocal IOL (AcrySof IQ SN60WF; Alcon Laboratories, Inc., USA) and a trifocal IOL (AcrySof IQ PanOptix; Alcon Laboratories, Inc., USA) was assessed using an in vitro optical bench (OptiSpheric IOL R&D; Trioptics GmbH, Germany). At apertures of 3.0 mm and 4.5 mm, modulation transfer function (MTF) at spatial frequency of 50 lp/mm, MTF curve and the United States Air Force (USAF) resolution test chart of the two IOLs were measured and compared at their focus with different degrees of decentration and tilt. Optical quality at infinity, 60 cm and 40 cm and the through-focus MTF curves were compared when the two IOLs were centered at apertures of 3.0 mm and 4.5 mm. Spectral transmittance of the two IOLs was measured by the UV-visible spectrophotometer (UV 3300 PC; MAPADA, China)., Results: The SN60WF and the PanOptix filtered blue light from 400 to 500 nm. Both IOLs at the far focus and the PanOptix at the intermediate focus showed a decrease in optical quality with increasing decentration and tilt. The PanOptix demonstrated enhanced optical quality compared to the previous gradient at the near focus at a decentration range of 0.3-0.7 mm with a 3.0 mm aperture, and 0.5 mm with a 4.5 mm aperture, whereas other conditions exhibited diminished optical quality with increasing decentration and tilt at the focus of both IOLs. When the two IOLs were centered, the SN60WF had better optical quality at infinity, while the PanOptix had better optical quality at 60 cm and 40 cm defocus. The optical quality of the SN60WF exceeded that of the PanOptix at far focus, with a 3 mm aperture decentration up to 0.7 mm and a 4.5 mm aperture decentration up to 0.3 mm; this observation held true for all tilts, irrespective of aperture size. As both decentration and tilt increased, the optical quality of the SN60WF deteriorated more rapidly than that of the PanOptix at the far focal point., Conclusions: The SN60WF showed a decrease in optical quality with increasing decentration and tilt. Optical quality of the PanOptix at the near focus increased in some decentration conditions and decreased in some conditions, while it showed a decrease at the other focuses with increasing decentration. While tilt only had a negative effect on optical quality. When both IOLs were centered, the PanOptix provided a wider range of vision, while the SN60WF provided better far distance vision. At the far focus, the SN60WF has better resistance to tilt than the PanOptix, but the optical quality degrades more quickly when decentered and tilted., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The aim of this study was to develop a methodology, based on profilometer measurements to assess the optical behaviour of Intraocular Lenses (IOls). The "Modulation Transfer Function through-object" (MTF through-object) based on vergence object displacement was calculated for different pupil sizes and pseudophakic eyes. Tilt and decentration were also analysed in a realistic cornea eye model., Methods: For comparison between the different IOLs, an optical quality criterion based on a minimum value the MTF through-object and the recognition of simulated vision optotypes was introduced. Five IOLs were used in this study: Tecnis Eyhance, Mini Well, Tecnis Symfony, Tecnis Synergy and RayOne EMV., Results: The technique was validated with previous methodologies. A general narrowing of the through-object MTF curve compared to the through-focus MTF curve was shown, resulting in greater distances between near and intermediate points and less depth of field around the far peak. The comparison between the IOLs showed that variations in corneal aberrations, pupil size and decentration caused relevant changes in IOL performance. A decrease of the SA produced a hypermetropic shift of the far focus between + 0.3 D and + 0.4 D. Most of IOLs worsen the optical quality as pupil size increased, even the MTF through-object shape changed. Decentration was an important factor in IOL implantation, causing a significant change in MTF through-object shape in most of IOLs., Conclusions: This study highlights the need to evaluate pre-operative patients for corneal aberrations and pupillary size to have the best optical success after cataract surgery in multifocal or extended depth of focus IOLs., Key Messages: What is known MTF(Modulation Transfer Function) through-focus curves (calculated in image space by moving the detector plane) can be obtained from optical bench assembly or from commercial devices. Recently, some studies proposed to characterize the lens surface design based on the profilometric measurements What is new A novel methodology based on profilometer measurements to assess the optical behaviour of Intraocular Lenses (IOls) was shown. The "Modulation Transfer Function through-object" based on vergence object displacement was introduced in order to analyse five premium IOLs. MTF through-object curve is more appropriate for studying clinical behaviour, as it provides further near and intermediate points distances and lower depth of focus around far peak compare to MTF through-focus curves. The optical behaviour of the five IOLs can vary considerably depending on the eye model and pupil size. The effect of tilt and decentration on the MTF through-object the IOLs was analysed., (© 2024. The Author(s).)

Purpose: This study aimed to investigate the in vitro tolerance to decentration of biaspheric intraocular lens (IOLs) with refractive phase-ring extended depth-of-focus (EDOF) and diffractive trifocal designs., Methods: This experimental study was carried out at the Department of Optics and Optometry and Vision Science, University of Valencia, Spain. The modulation transfer function (MTF) of the ETLIO130C EDOF and the TFLIO130C trifocal IOLs (AST Products Inc., Billerica, MA, USA) were determined at different levels of decentration for a given wavelength and pupil diameter using the PMTF optical bench (Lambda-X Ophthalmics, Nivelles, Belgium). The modulation transfer function (MTF) curves, the through-focus MTF curves, and the Strehl ratios were measured at 3-mm pupil aperture for 0.25-, 0.50- and 0.75-mm decentration., Results: The optical design of the trifocal TFLIO130C IOL is robust to small decentrations, with virtually no change in MTF response for 0.25 mm decentration. For greater decentration levels, the MTF response is slightly reduced with increasing decentration. The ETLIO130C EDOF design is robust to decentration, as the MTF response is only minimally affected when increasing the decentration up to 0.75 mm., Conclusions: MTF responses are slightly reduced with greater levels of decentration, but the range of focus provided by both trifocal and EDOF designs are preserved. The effects for average levels of decentration reported in the literature are minimum for both IOL designs., (© 2024. The Author(s).)

Pupil diameter is a key parameter for corneal and multifocal intraocular lens surgery. Many devices are dedicated to measure the pupil size, but do not specify the illumination during capture. The aim of this study was to present illumination levels in routinely used ophthalmic devices which present pupil sizes. To obtain measurements, the lux meter was placed in the chin rest in the corneal plane and the room was completely dimmed. Ten measurements were taken for each device. The illumination levels for white and red Placido disk corneal topographers were 1253.1 ± 0.2 and 329.0 ± 0.2 lux, respectively (both photopic conditions). Scheimpflug corneal tomography should be considered as a mesopic measurement (14.5 ± 0.1 lux). Optical coherence tomography and autorefractometry are scotopic measurements (0.4-0.6 lux). We postulate that producers should provide illumination levels of their devices measuring pupil size. Moreover, when mentioning a pupil size, one should consider presenting to what lighting conditions it refers to., (© 2023. The Author(s).)

Purpose: With the aging population, the prevalence of presbyopia and the popularity of multifocal intraocular lenses is also growing worldwide. Unfortunately, in some cases, they are still associated with postoperative visual disturbances. Recent literature started to evaluate angle kappa- and angle alpha-derived metrics of chord mu and chord alpha as possible predictive values for visual outcomes after multifocal intraocular lens implantation but the published results are inconsistent between studies. Thus, this article aims to review the role of chord mu and chord alpha as postoperative predictors after multifocal intraocular lens implantation and lay the foundation for further research., Methods: Relevant articles were identified using the following keywords: "presbyopia," "multifocal intraocular lens," "angle kappa," "angle alpha," "Chord mu," and "Chord alpha" up to June 2022. An attempt was made to present the majority of publications that addressed the topic., Conclusions: Chord mu and chord alpha have a predictive role on the outcomes after multifocal intraocular lens implantation but to a different extent. Cataract surgeons should take them into consideration and avoid implanting a multifocal intraocular lens for patients with speculated critical values of chord mu and alpha above 0.5-0.6 mm, depending on the device used for measurement and the multifocal intraocular lens implanted. Currently, chord alpha seems to be a more stable, more widely applicable, and reliable determinant in predicting postoperative outcomes and in patient selection prior to multifocal intraocular lens implantation when compared to chord mu. To draw conclusions on the topic, a controlled study is needed., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose:  To analyze and compare the visual performance and patient satisfaction following the implantation of toric multifocal intraocular lenses (TMIOLs) in adult patients with different types of developmental cataracts (DC) accompanied by corneal astigmatism (CA)., Methods:  This is a prospective observational cohort study. Patients diagnosed with DC aged 18-30 years were divided into three groups according to the anatomic location of the lens opacity: cortical, nuclear, and posterior subcapsular (PSC) groups, and implanted with TMIOLs. Visual acuity (VA), postoperative refractive astigmatism (RA), intraocular lens (IOL) rotation, high-order aberrations (HOAs), modulation transfer function (MTF) curve, and Strehl ratio were compared. The functional vision and incidence of photic phenomena were surveyed using questionnaires., Results:  Fifty-five eyes of 37 patients were enrolled and completed a 1-year follow-up. The mean CA was 2.06 ± 0.79 D preoperatively, and the mean RA was 0.29 ± 0.30 D 3-month postoperatively. The IOL rotation was 2.48° ± 1.89°, with no deviation > 10°. At 12 months, mean uncorrected distance VA improved from 0.93 ± 0.41 preoperatively to 0.08 ± 0.08 logarithm of the minimum angle of resolution (logMAR), mean uncorrected near VA increased from 0.45 ± 0.30 preoperatively to 0.12 ± 0.11 logMAR, and mean uncorrected intermediate VA was 0.14 ± 0.08 logMAR. The cortical and nuclear groups displayed better improvements in uncorrected near and intermediate VA than that in the PSC group. Similar results were observed in the 3-month defocus curves, HOAs, MTF curve, halo incidence, and near vision satisfaction., Conclusion: In adult patients with DC accompanied by CA, TMIOLs implantation achieved good postoperative visual outcomes and significantly reduced glasses dependency. Patients with cortical or nuclear lens opacity showed better whole-course VA and quality of vision, while patients with PSC opacity showed unsatisfactory near vision and suffered more photic phenomena., (© 2023. The Author(s).)

Purpose: To assess how eye axes and multifocal intraocular lens (MIOL) centration may impact the light distortion index (LDI) and ocular scatter index (OSI)., Methods: Fifty-eight subjects implanted with the trifocal MIOL Q-Flex M 640PM or Liberty 677MY (Medicontur) were included in this retrospective analysis. The following variables were collected with the Pentacam Wave (Oculus) considering the vertex normal as the coordinates center: chord-mu to the center of the pupil, chord-alpha to the geometrical center of the cornea, and chord-MIOL to the center of the diffractive ring. These measurements were correlated with OSI (HD Analyzer, Visiometrics) and LDI (light distortion analyzer, CEORLab)., Results: Chord-MIOL centroid was 0.12 mm at 62°, chord-mu was 0.09 mm at 174°, and chord-alpha was 0.38 mm at 188°. A relationship was found between OSI and LDI, rho = 0.58, p < 0.0005). No relationships were found between chord-mu or chord-alpha and the LDI or OSI, neither for the total magnitude, nor the decomposition in orthogonal components (p > 0.05). The LDI was significantly correlated with the temporal centration of the MIOL versus the vertex normal (rho = 0.32, p = 0.02)., Conclusions: As opposed to what has been previously described, the temporal centration of the MIOL was related to a decrease in the LDI. Future studies with extreme values of the included variables are required to establish cut-offs for considering these variables as exclusion criteria in the implantation of a MIOL., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To evaluate binocular visual function after unilateral and bilateral implantation of segmented refractive multifocal intraocular lenses (MIOLs)., Methods: This prospective comparative pilot study included patients who underwent SBL-3 (Lenstec; + 3.00 D) implantation at Peking University Third Hospital. Patients were divided into two groups (monocular or binocular surgery). Thirty-two patients with emmetropic presbyopic contralateral eyes and 49 patients with bilateral SBL-3 implantation within a week between eyes were included in the unilateral SBL-3 and bilateral groups, respectively. At 3-month follow-up, the main outcomes were binocular uncorrected distant, intermediate, and near visual acuity (UDVA, UIVA, and UNVA). Secondary outcomes included binocular best-corrected visual acuity at all distances, defocus curve, contrast sensitivity, photic phenomena, spectacle independence, patient satisfaction, and National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) score. The essential perceptual phenomena constituting binocular vision, simultaneous perception, fusion, and stereopsis were also evaluated., Results: Both groups showed similar binocular UDVA and UIVA, but UNVA was significantly better in the bilateral group (0.07 ± 0.07 versus 0.12 ± 0.07, P = 0.008). Better binocular defocus curve at intermediate to near focal points, higher percentage of spectacle independence at near distance, and NEI-VFQ-25 near activity scores were observed in the bilateral group. No significant differences in contrast sensitivity, photic phenomena, overall satisfaction, other NEI-VFQ-25 subscales, fusional amplitude, and stereoacuity were found between groups., Conclusion: Unilateral implantation of segmented refractive MIOL provided desirable distant visual acuity and high patient satisfaction, but inferior intermediate and near visual outcomes compared with bilateral implantation., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To evaluate the feasibility of scleral fixation of subluxated or dislocated multifocal/multifocal toric intraocular lenses (IOLs) to rescue the IOL and restore both near and far vision., Method: A total of 18 eyes of 17 patients who underwent transscleral or intrascleral fixation of subluxated or dislocated multifocal or multifocal toric IOLs at 2.5 mm posterior to the limbus were enrolled. Preoperative uncorrected distance visual acuity (UDVA) and postoperative UDVA values were compared in this retrospective cross-sectional study. The postoperative corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA) at 40 cm, residual sphere, cylinder, spherical equivalent, and IOL centration were evaluated., Results: The mean follow-up period was 4.0 ± 5.0 months. The mean preoperative UDVA was 0.73 ± 0.71 logMAR and the postoperative UDVA was 0.05 ± 0.10 logMAR, which was significantly improved relative to the preoperative UDVA. The mean postoperative CDVA was 0.00 ± 0.00 logMAR and the mean postoperative UNVA at 40 cm was 0.05 ± 0.07 logMAR. The mean postoperative residual sphere, cylinder, and spherical equivalent values were - 0.21 ± 0.41 D, - 0.29 ± 0.26 CD, and - 0.33 ± 0.39 D, respectively. Postoperative anterior segment photographs showed good centration of optics in all cases of single-piece foldable multifocal IOLs but a slight inferior decentration in one case of a three-piece multifocal IOL., Conclusion: Scleral fixation of subluxated or dislocated multifocal and multifocal toric IOLs could be one of the treatment options to rescue subluxated or dislocated multifocal IOLs and restore both near and far vision., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To compare the internal aberrations and optical quality after femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS)., Methods: This study included patients who received FLACS or CPCS from January 2016 to July 2019. Postoperative examinations included wavefront measurements under pupil diameters of 3.0 mm and 5.0 mm, intraocular lens (IOL) decentration, visual acuity (VA), and refractive outcomes. Visual quality was measured with Strehl ratio and modulation transfer function (MTF). Subgroup analyses were conducted based on monofocal or multifocal-extended depth of focus (EDOF) IOL., Results: The study consisted of 221 eyes (105 eyes in FLACS and 116 eyes in CPCS). With a pupil diameter of 5.0 mm, FLACS demonstrated a significantly lower root mean square of total internal aberration (P = 0.004), higher order aberrations (HOAs) (P = 0.034), tilt (P = 0.049), coma (P = 0.004), and spherical aberration (P = 0.014). IOL tilt was found to be positively correlated with total internal aberration (P < 0.001), HOAs (P < 0.001), and coma (P < 0.001). The FLACS group presented significantly smaller IOL decentration than the CPCS group (P < 0.001), but there were no significant differences in terms of VA and refractive outcomes between groups. In the multifocal-EDOF subgroup, Strehl ratio and MTF values were significantly higher in the femtosecond group with a 3.0-mm pupil., Conclusion: FLACS induced significantly lower values of IOL tilt, decentration, and internal aberrations compared with the CPCS group with a pupil diameter of 5.0 mm, while no significant differences were found in the VA or optical quality over long-term observation., Trial Registration: This trial was registered at www.chictr.org.cn (registration number ChiCTR2000038965)., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To assess the degree of posterior capsular opacification (PCO) and its influence on contrast sensitivity defocus curve (CSDC) after implantation of two trifocal intraocular lenses (IOLs), Alsafit (AT) and Liberty (L), during a 12-month follow-up. A secondary aim was to evaluate the Nd:YAG capsulotomy rate in a long time., Methods: Data from 63 subjects, 34 implanted with AT and 29 with L, were retrospectively analyzed for this pilot study. In those eyes without capsulotomy during the first year (n = 58), CSDC at 3 and 12 months after surgery and PCO grading were measured, with additional answering of a visual function questionnaire (VF-14) and a question of general satisfaction. The period after surgery up to capsulotomy or last on-demand visit without Nd:YAG was recorded for survival analysis beyond the 12-month follow-up., Results: Total area under CSDC (TAUC) between 3 and 12 months decreased from 2.96 to 1.71 for AT (p < 0.05) and from 2.73 to 2.21 (p > 0.05) for L. Of eyes, 51.6, 19.3, and 29% with AT were graded as level 0, 1, and 2 of PCO, while 85.1, 11.1, and 3.7% of eyes with L were graded as level 0, 1, and 2 (p < 0.05). PCO grading was correlated with a decrease of TAUC (ρ =  - 0.27, p = 0.04). Median time to require capsulotomy was 22 months with AT and 30 months with L (p < 0.05)., Conclusions: PCO decreases CSDC in patients with trifocal lenses. Despite using the same hydrophilic material, PCO grading and Nd:YAG capsulotomy rate was higher for AT than for L., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To determine the influence of mild non-foveal involving epiretinal membrane (ERM) on visual outcome in eyes with multifocal intraocular lens (MIOL) implantation., Methods: Patients with history of MIOL implantation were screened for the presence of ERM using spectral-domain optical coherence tomography (SD-OCT) at postoperative 6 months. Ninety-one eyes with mild non-foveal involving ERM and history of MIOL implantation were compared with 83 age-matched controls without ERM and history of MIOL implantation. The visual acuity (corrected and uncorrected) and visual quality (contrast sensitivity, Strehl ratio, area ratio, and higher-order aberrations; HOAs) of the eyes with mild non-foveal involving ERM were compared with the data of the age-matched control group., Results: There was no difference in visual acuity between the groups at baseline and postoperative 6 months. The mild non-foveal involving ERM group showed significantly low contrast sensitivity at a visual angle of 4.0°, 2.5°, 1.0°, and 0.64° under scotopic conditions (P = .048, P = .025, P = .003, and P = .02, respectively) and 4.0°, 1.0°, and 0.64° under photopic conditions (P = .028, P = .002, and P = .001, respectively). The mean area ratio of the mild non-foveal involving ERM group was 45.13 ± 10.93, which was significantly lower than that of the control group, which measured 50.34 ± 12.66 (P = .044)., Conclusion: A mild non-foveal involving ERM has no effect on visual acuity, but it reduces visual quality in eyes with MIOL implantation. A thorough screening using SD-OCT is warranted for this condition when considering MIOL implantation., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To evaluate the effect of visual axis positioning on the optical performance of the Tecnis MIOL and the Diff-aA MIOL., Methods: In this prospective, randomized comparative study, 70 eyes of 35 subjects with senile cataract were implanted with the spherical aberration-correcting diffractive, bifocal Tecnis ZLB00 IOL and 60 eyes of 30 age-matched subjects with the spherical aberration neutral, diffractive, bifocal Diffractiva IOL. Observation procedure was performed 1, 3, and 6 months postoperatively. Main outcome measures included uncorrected and corrected distance and near visual acuity, manifest refraction, ocular aberrations, and visual quality metrics with 2 mm and 4 mm pupil and the position of visual axis., Results: At the 6-month visit, no significant difference was found in monocular and binocular uncorrected (UDVA) and corrected (CDVA) distance and near (UNVA, CNVA) visual acuity between the groups. Spherical and coma-like aberrations were similar measured with a 2-mm pupil, but with a 4-mm pupil, the SA was significantly larger (in negative direction) in the Diffractiva group. The higher-order Strehl ratio and MTF was significantly larger in the Diffractiva group measured at 2 mm entrance pupil; however, this difference disappeared by the 4-mm pupil measurements. Postoperative angle alpha distance had a significant influence on HO Strehl value., Conclusions: The size of angle alpha is a predictive factor of image quality by multifocal IOL patients., Trial Registration: Trial registration number and date of registration: NCT04274088, 14.02.2020.

The functional results and the occurrence of side effects (especially photic phenomena) for multifocal intraocular lenses (IOL) are difficult to predict. Furthermore, in the course of life patients can develop diseases in which a multifocal optic would be a disadvantage. In these cases exchange of the IOL is the only treatment option. Implantation of a monofocal or monofocal toric IOL in the capsular bag and a supplementary trifocal IOL in the ciliary sulcus in a single operation, known as a duet procedure, provides trifocality that can be easily reversed if necessary.

Purpose: This study was conducted to investigate factors related to postoperative good near and distance visual outcomes in the Lentis Mplus LS-313 MF20 (Oculentis Gmbh, Berlin, Germany) intraocular lens (IOL)-implanted eye., Methods: A retrospective cross-sectional study analyzed a total of 198 eyes of 198 patients. Patients with 20/20-or-more uncorrected distance visual acuity (UDVA, 5 m) and J2-or-more uncorrected near visual acuity (UNVA, 40 cm) were distributed into the good visual outcome (GVO) group (n = 96), and the remaining patients were distributed into the moderate visual outcome (MVO) group (n = 102). Differences between the two groups were compared for patient age, preoperative measurements (kappa distance, kappa angle, and pupil size), and postoperative measurements (residual sphere, cylinder, and spherical equivalent) to explore factors related to good visual outcomes after IOL implantation., Results: The average age of the GVO group (56.2 years) was significantly lower than that of the MVO group (58.6 years), and the average kappa distance of the former was significantly smaller than that of the latter. However, there were no significant differences between the two groups in kappa angle and pupil size. Notably, multivariate binary regression analysis revealed that multiple factors including age, residual cylinder, and spherical equivalent were associated with good visual outcomes. Based on the receiver operating characteristic curve, cutoff values regarded as good visual outcome following cataract surgery were calculated to be - 0.38 CD in residual cylinder and - 0.32 D in residual spherical equivalent., Conclusions: Patients with implanted Lentis Mplus LS-313 MF20 IOL who are young, had small kappa distance, and had low levels of postoperative residual cylinder and spherical equivalent tended to exhibit good vision at both near and distance. These results imply that surgeons should minimize postoperative residual cylinder and spherical equivalent to provide good visual outcomes to patients with implanted Lentis Mplus LS-313 MF20 IOL.

Purpose: To investigate posterior vitreous detachment (PVD) and pars plana vitrectomy (PPV) effects on contrast sensitivity function (CSF) in patients with a multifocal intraocular lens (MfIOL)., Methods: This single-center prospective case-control study analyzed 27 patients with 43 consecutive eyes. Twenty patients with 36 consecutive eyes received MfIOL implantation with either ZLB00 or ZMB00. CSF was measured as the area under the log contrast sensitivity function (AULCSF) in the presence and absence of PVD (PVD+ group and PVD- group, respectively). Seven eyes associated with a symptomatic PVD and severe visual dissatisfaction after MfIOL implantation underwent PPV (symptomatic PVD+ group). CSF was measured prior to and after PPV., Results: The mean AULCSF was significantly lower in the PVD+ group (1.5 ± 0.1) versus the PVD- group (1.7 ± 0.1, p < 0.0001). Major complaints in the symptomatic PVD+ group included floaters (n = 2) and blurry vision (n = 5). The preoperative AULCSF (1.4 ± 0.1) was significantly lower in the symptomatic PVD+ group versus the PVD- group (p < 0.0001) and PVD+ group (p = 0.02). The preoperative AULCSF in the symptomatic PVD+ group was significantly improved after PPV (1.4 vs. 1.7, respectively, p = 0.002)., Conclusions: PVD significantly decreased CSF in patients with MfIOL. Patients with symptomatic PVD exhibited the greatest decrease in CSF, which was significantly improved after PPV. Measurement of CSF and careful assessment of PVD may be useful in determining the appropriateness of surgical intervention for improving visual performance and satisfaction in MfIOL patients with symptomatic PVD.

Purpose: To investigate the refractive results of a LASIK enhancement and its impact on treatment safety, efficacy, predictability and patient reported outcome in eyes after clear lens extraction and diffractive trifocal lens implantation., Methods: A retrospective cohort multicentre study of Care Vision Refractive Centres in Germany compared two groups of patients. Group 1 consisted of eyes that had non-toric MIOL surgery only, whereas group 2 had a consecutive laser enhancement after 3 months follow-up. Refractive and subjective results of the two groups were compared. Patient reported outcome measurements were assessed by using a 30-item questionnaire with four subscales. (Spectacle Dependence, Eye Comfort, Freedom and Looking/Feeling Well). Refractive results were reported following standard reporting in refractive surgery., Results: 139 eyes of 79 patients were included in which either MIOL surgery or MIOL surgery plus LASIK enhancement had been performed between January and December 2017. UDVA reached 0.1logMAR (0.8; 20/25) in 94% in group 2 and 85% in group 1. Compared to preoperative CDVA no change in Snellen lines of CDVA was shown in 89% in group 1 and in 93% in group 2. Spectacle dependence (P = 0.41), eye comfort (P = 0.15), freedom (P = 0.48) and looking/feeling well (P = 0.45) showed no statistically significant difference between both the groups., Conclusions: In patients with residual ametropia after MIOL implantation, LASIK provides a reliable, safe and efficient way to achieve the desired refractive outcome and patient satisfaction. We recommend performing Laser enhancement at 3 months after MIOL implantation (Bioptics) in trifocal MIOL patients that benefit from improvement of residual ametropia.

Patients undergoing lens surgery nowadays have the option to choose between different intraocular lens (IOL) options depending on the ocular situation and personal preferences. For example, it is possible to implant a toric IOL to compensate for extensive corneal distortion or a multifocal IOL to have good visual acuity at various distances. The high level of competition in the lens market leads to fast development of new lens models giving patients the advantage to choose between a variety of options. This review article presents the most commonly used premium IOL options namely, aspheric, toric and multifocal IOLs and a summary of the current study situation for the different lens types. Compared to standard lenses, these lenses can improve uncorrected distance and near visual acuity; however, in some patients the added benefit can be only marginal and this is then an unnecessary cost factor for the patient. Furthermore, if inclusion and exclusion criteria are not respected the special forms of lenses can even lead to a poorer overall result.

Purpose: Multifocal intraocular lenses (IOLs) offer the possibility of spectacle-free vision following cataract surgery compared to standard IOLs. Existing systematic reviews have generally concluded that multifocal IOLs result in better uncorrected near vision and greater spectacle independence, but more unwanted visual phenomena such as glare and halos, compared to monofocal IOLs. However, the certainty of evidence has been low for most outcomes, and pooled analyses have grouped together technologically obsolete lenses with newer lenses, potentially obscuring differences in performance across different lens types., Methods: We performed a systematic review searching for RCTs of a multifocal IOL to a standard IOL or monovision that reported spectacle independence, visual acuity, or quality of life. Databases were searched from 1/1/2006-4/30/2017. Existing reviews were used to identify older studies. Title/abstract screening and data extraction were done in duplicate. Where possible, random effects meta-analysis was performed to synthesize results. In addition to comparing multifocal IOLs as a group to monofocal IOLs, we also compared newer diffractive lenses to obsolete or refractive lenses., Results: Twenty-five eligible studies were identified. There was no difference in pooled estimates of corrected or uncorrected distance vision between multifocal and standard IOLs. Compared to monofocal IOLs, multifocal IOLs had statistically significantly better pooled results for the outcome of near vision (10 studies, 1025 patients, mean difference in logMAR of -0.26 (95% CI -0.37, -0.15)); spectacle dependence (12 studies, 1237 patients, relative risk of 0.27 (95% CI 0.20, 0.38)) and borderline significantly better quality of vision (6 studies, 596 patients, standardized mean difference of -0.54, (95% CI -1.12, 0.04)). Compared to monofocal IOLs, multifocal IOLs had statistically significantly worse pooled results for the outcomes of glare (9 studies, 847 patients, risk ratio of 1.36 (95% CI 1.15, 1.61) and halos (7 studies, 754 patients, risk ratio of 3.14 (95% CI 1.63, 6.08). Newer multifocal lenses had statistically significantly better outcomes than older diffractive lenses or refractive lenses, when compared to monofocal IOLs, in near vision, quality of vision, and risk of halos., Conclusions: Multifocal IOLs compared to standard IOLs or monovision result in better uncorrected near vision and a higher proportion of patients who achieve spectacle independence, but greater risk of unwanted visual phenomena. Newer diffractive lenses may be better than refractive lenses in near vision and quality of vision outcomes, with less risk of halos than older diffractive lenses and refractive lenses. (PROSPERO registration CRD42017069949).

A 52-year-old highly myopic female patient was implanted with a multifocal, diffractive, toric intraocular lens because of the wish to be independent of eyeglasses. Despite high-quality, extensive preoperative examinations, a hyperopic refractive error remained postoperatively, which led to the patient's dissatisfaction. This error was treated with Laser-in-situ-Keratomileusis (LASIK). After corneal LASIK treatment and implantation of a diffractive toric multifocal intraocular lens the patient showed a good postoperative visual result without optical phenomena.

Background: Refractive lens exchange and implantation of a multifocal intraocular lens (MIOL) is mainly advised for ametropes with presbyopia. Non-presbyopic young ametropes who wish spectacle-independence are usually treated with corneal refractive surgery or phakic lenses., Objectives: This retrospective case series aimed to analyse the refractive and subjective satisfaction outcome after MIOL surgery in both eyes of non-presbyopic ametropes where other treatment options were not possible., Materials and Methods: This retrospective case series comprised consecutively treated 32 eyes of 16 patients (5 myopic, 11 hyperopic patients; mean age 31 ± 6 years) who wished spectacle-independence and thus received an aspheric bifocal biconvex refractive-diffractive single-piece MIOL (Acri.Lisa 366/809, Carl Zeiss Meditec AG). Refractive data prior to and after surgery as well as subjective satisfaction at the 1‑year follow-up examination were assessed., Results: Related to distance corrected near visual acuity myopic eyes had a median efficacy index (EI) of 0.92 (±0.20) and hyperopes of 0.91 (±0.12) (P = 0.415). For intermediate vision, in both groups a lower EI (<0.5; P = 0.188) resulted in lower subjective satisfaction, which was higher for near and distance vision. Some of hyperopic patients reported limitations in near and distance vision, only one hyperopic patient would not have chosen this surgery again. None had a related complication during the follow-up., Conclusions: When neither laser refractive surgery nor implantation of a phakic lens is possible, young non-presbyopic ametropes do profit from MIOL surgery with an aspheric bifocal biconvex refractive-diffractive MIOL.