Clinical and self-reported outcomes after multifocal intraocular lens implantation of patients with stable keratoconus

Abstract

Multifocal intraocular lens (IOL) implantation is generally not considered in patients with keratoconus; however, it may provide good optical results in selected patients based on two case reports. To evaluate patient satisfaction and clinical outcomes in this patient population. This is a retrospective single-center, non-comparison study. All patients with frank keratoconus who had undergone a trifocal IOL implantation between 2016 and 2019 were invited to participate in this study (18 eyes of 9 patients were included). Postoperatively, refractive outcomes, contrast sensitivity, and ocular aberrations were recorded. A questionnaire was used for determining patient satisfaction and their quality of life. The mean follow-up time was 31.22 ± 6.38months. Postoperatively the patients' uncorrected distance visual acuity improved from 1.13 ± 0.93 logMAR to 0.10 ± 0.17 (p ˂ 0.001), corrected distance visual acuity went from 0.10 ± 0.11 to 0.05 ± 0.09 (p = 0.19), mean refractive spherical equivalent changed from -4.34 ± 4.31 to 0.05 ± 0.51 D (p ˂ 0.001), and manifest astigmatism from 2.44 ± 1.92 to 0.88 ± 1.81 D (p = 0.017). A postoperative MRSE of less than ± 0.50 D was achieved in 17 eyes (94%). Three eyes (17%) lost 1 line of best corrected visual acuity and no patient lost two or more lines. The patients were independent of glasses in 78% for all distances. One patient who required an IOL exchange due to photic phenomena was lost to follow-up. Use of a trifocal IOL provided relatively predictable refractive outcomes and spectacle independence in most of this small cohort of patients with stable frank keratoconus.