Abstract
BackgroundTo compare the clinical performance of bifocal and trifocal intraocular lenses (IOLs) in cataract surgery, a meta-analysis on randomized controlled trials was conducted.MethodsA comprehensive literature retrieval of PubMed, Science Direct and EMBASE was performed in this systematic review. Clinical outcomes included visual acuity (VA), contrast sensitivity (CS), spectacle independence, postoperative refraction and surgical satisfaction.ResultsThere were 8 RCTs included in this study. The difference of uncorrected near VA (UNVA) between the bifocal IOLs and trifocal IOLs had no significance [MD = 0.02, 95%CI: (− 0.03,0.06)]. There was no significant difference in the distant-corrected near VA (DCNVA) with MD of 0.04 [95%CI (− 0.02, 0.10)]. Compared with trifocal group, the uncorrected intermediate visual acuity (UIVA) [MD = 0.09,95%CI:(0.01,0.17)] was significantly worse in the bifocal group. No difference was found in distance-corrected intermediate VA (DCIVA) [MD = 0.09, 95%CI: (− 0.04, 0.23)] between two groups. Analysis on AT LISA subgroup indicated the bifocal group had worse intermediate VA than trifocal group (AT LISA tri 839 M) [MD = 0.18, 95%CI: (0.12, 0.24) for UIVA and MD = 0.19, 95%CI: (0.13, 0.25) for DCIVA]. However, there was no statistically significant difference between the two groups in the uncorrected distance VA (UDVA) and corrected distance visual acuity (CDVA) [MD = 0.01, 95%CI: (− 0.01,0.04) for UDVA; MD = 0.00, 95%CI: (− 0.01,0.01) for CDVA].The postoperative refraction of bifocal group was similar to that of trifocal group [MD = -0.08, 95% CI: (− 0.19, 0.03) for spherical equivalent; MD = -0.09, 95%CI: (− 0.21, 0.03) for cylinder; MD = -0.09, 95% CI: (− 0.27, 0.08) for sphere]. No difference was found for spectacle independence, posterior capsular opacification (PCO) incidence and patient satisfaction between bifocal IOLs and trifocal IOLs. [RR = 0.89, 95% CI: (0.71, 1.12) for spectacle independence; RR = 1.81, 95% CI: (0.50, 6.54) for PCO incidence; RR = 0.98, 5% CI: (0.86, 1.12) for patient satisfaction].ConclusionPatients receiving trifocal IOLs, especially AT LISA tri 839 M, have a better intermediate VA than those receiving bifocal IOLs. Near and distance visual performance, spectacle independence, postoperative refraction and surgical satisfaction of bifocal IOLs were similar to those of trifocal IOLs.
Highlights
To compare the clinical performance of bifocal and trifocal intraocular lenses (IOLs) in cataract surgery, a meta-analysis on randomized controlled trials was conducted
There was no significant difference in the distant-corrected near visual acuity (VA) (DCNVA) with MD of 0.04 [95%CI (− 0.02, 0.10)]
No difference was found in distance-corrected intermediate VA (DCIVA) [MD = 0.09, 95%CI: (− 0.04, 0. 23)] between two groups
Summary
To compare the clinical performance of bifocal and trifocal intraocular lenses (IOLs) in cataract surgery, a meta-analysis on randomized controlled trials was conducted. Cataract is the clouding of the normally clear crystalline lens or loss of transparency, which reduces the amount of incoming light and impairs visual perception, and it is the leading cause of vision impairment and blindness worldwide. Data from the World Health Organization (WHO) showed that cataract accounted for approximately 50% of blindness worldwide [1]. In China, blindness and low vision affects about 5.8% of Chinese aged 50 and above [2]. It is generally acknowledged that cataract surgery is the most cost-effective way for restoring vision.
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