Visual performance of the intraindividual implantation of a trifocal intraocular lens in the bag and a +4.0 D bifocal intraocular lens in the sulcus with optic capture created by femtosecond laser-assisted cataract surgery

At present, only one design is available for trifocal intraocular lens (IOL); unfortunately, this particular design is not suitable for implantation in the sulcus with optic capture when posterior capsule rupture (PCR) occurs. Although three-piece bifocal IOLs can be implanted in the sulcus, this form of IOL can be vulnerable to tilt and decentration, thus causing aberration and photopic phenomena, such as halos and glares. However, visual axis centered optic capture using femtosecond laser-assisted cataract surgery (FLACS) is able to manage such complex operations. In the present study, we implanted a three-piece +4.0 D bifocal IOL into the sulcus of a patient who experienced PCR using optic capture and FLACS following the straightforward implantation of a one-piece trifocal IOL in the other eye. Defocus curves showed that the weakness of the trifocal IOL (nearest distances) was compensated for by the strength of the +4.0 D bifocal IOL, whereas the weakness of the +4.0 D bifocal IOL (middle distance) was compensated for by the strength of the trifocal IOL. Therefore, this combination provided the patient with a wider range of depth of focus. The contrast sensitivity in both eyes was within the normal range. Photopic phenomena were comparable with the bilateral implantation of the trifocal IOL. Anterior segment optical coherence tomography showed that tilt and decentration in the trifocal IOL implanted in the bag was significantly higher than the +4.0 D bifocal IOL implanted in the visual axis centered optic capture. This case showed that the intraindividual implantation of a single-piece trifocal IOL in the bag and a three-piece +4.0 D bifocal IOL in the sulcus, using a combination of optic capture and FLACS, is promising particularly in cases of PCR and can provide a wider range of vision without losing visual quality.

[1]  Sangyeol Lee,et al.  Comparison of two laboratory-based systems for evaluation of halos in intraocular lenses , 2018, Clinical ophthalmology.

[2]  B. Cochener,et al.  Visual Performance With Bifocal and Trifocal Diffractive Intraocular Lenses: A Prospective Three-Armed Randomized Multicenter Clinical Trial. , 2017, Journal of refractive surgery.

[3]  T. Kohnen,et al.  Intraindividual comparative analysis of the visual performance after cataract surgery with implantation of a trifocal and a bifocal intraocular lens. , 2017, Journal of cataract and refractive surgery.

[4]  B. Cochener.  Prospective Clinical Comparison of Patient Outcomes Following Implantation of Trifocal or Bifocal Intraocular Lenses. , 2016, Journal of refractive surgery.

[5]  T. Kohnen,et al.  Bilateral implantation of +2.5 D multifocal intraocular lens and contralateral implantation of +2.5 D and +3.0 D multifocal intraocular lenses: Clinical outcomes , 2016, Journal of cataract and refractive surgery.

[6]  W. Scott,et al.  Femtosecond laser-assisted primary posterior capsulotomy for toric intraocular lens fixation and stabilization. , 2015, Journal of cataract and refractive surgery.

[7]  D. Piñero,et al.  Comparative analysis of the visual performance after cataract surgery with implantation of a bifocal or trifocal diffractive IOL. , 2014, Journal of refractive surgery.

[8]  H. Gimbel,et al.  Reverse Optic Capture to Stabilize a Toric Intraocular Lens , 2013, Case Reports in Ophthalmology.

[9]  Damien Gatinel,et al.  Comparison of bifocal and trifocal diffractive and refractive intraocular lenses using an optical bench , 2013, Journal of cataract and refractive surgery.

[10]  James S. Wolffsohn,et al.  Visual outcomes and subjective experience after bilateral implantation of a new diffractive trifocal intraocular lens , 2013, Journal of cataract and refractive surgery.

[11]  Gianluca Carifi,et al.  Femtosecond laser capsulotomy. , 2011, Journal of cataract and refractive surgery.

[12]  T. Berendschot,et al.  Dissatisfaction after implantation of multifocal intraocular lenses , 2011, Journal of cataract and refractive surgery.

[13]  Maria A. Woodward,et al.  Patient acceptability of the Tecnis® multifocal intraocular lens , 2011, Clinical Ophthalmology (Auckland, N.Z.).

[14]  Yang Zhou,et al.  Visual function after monocular implantation of apodized diffractive multifocal or single‐piece monofocal intraocular lens: Randomized prospective comparison , 2010, Journal of cataract and refractive surgery.

[15]  Zoltan Nagy,et al.  Initial clinical evaluation of an intraocular femtosecond laser in cataract surgery. , 2009, Journal of refractive surgery.

[16]  Achim Langenbucher,et al.  Effect of decentration and tilt on the image quality of aspheric intraocular lens designs in a model eye , 2009, Journal of cataract and refractive surgery.

[17]  Gaetano Lodato,et al.  One-year outcomes with new-generation multifocal intraocular lenses. , 2008, Ophthalmology.

[18]  S. Sacu,et al.  Anterior chamber depth and change in axial intraocular lens position after cataract surgery with primary posterior capsulorhexis and posterior optic buttonholing , 2008, Journal of cataract and refractive surgery.

[19]  R. Menapace,et al.  Review article , 2004 .

[20]  Thomas Kohnen,et al.  European multicenter study of the AcrySof ReSTOR apodized diffractive intraocular lens. , 2006, Ophthalmology.

[21]  H. C. Yang,et al.  Decentration, tilt, and near vision of the Array multifocal intraocular lens , 2000, Journal of cataract and refractive surgery.

[22]  S. Pieh,et al.  Contrast sensitivity and glare disability with diffractive and refractive multifocal intraocular lenses , 1998, Journal of cataract and refractive surgery.

[23]  Gary J L Foster,et al.  Clinical and patient-reported outcomes of bilateral implantation of a +2.5 diopter multifocal intraocular lens. , 2017, Journal of cataract and refractive surgery.

[24]  T. Kohnen,et al.  Trifocal Intraocular Lens Implantation to Treat Visual Demands in Various Distances Following Lens Removal. , 2016, American journal of ophthalmology.

[25]  Thomas Sauer,et al.  Tilt and decentration of an intraocular lens implanted in the ciliary sulcus after capsular bag defect during cataract surgery , 2012, Graefe's Archive for Clinical and Experimental Ophthalmology.