AT LISA Tri Research Articles

Trifocal diffractive intraocular lens implantation in patients after previous corneal refractive laser surgery for myopia

BackgroundWith the difficulties in IOL power calculation and the potential side effects occurring postoperatively, multifocal IOL implantation after previous corneal refractive surgery are rarely reported especially for the trifocal IOL. Herein we report the clinical observation of trifocal IOL implantation in patients with previous myopia excimer laser correction. In this study, a multi-formula average method was performed for the IOLs power calculation to improve the accuracy. Visual and refractive outcomes were analyzed, and the subjective quality of patients’ life was evaluated by questionnaires survey.MethodsThis retrospective case series included patients with previous myopia excimer laser correction who underwent femtosecond laser assisted phacoemulsification and trifocal IOL (AT LISA tri 839 MP) implantation. Follow-up was done at 1-day, 1-month and 3-month to assess the visual outcomes. Outcome measures were uncorrected distance, intermediate and near visual acuity (UDVA, UIVA, UNVA), manifest refraction, defocus curve, and subjective quality of vision.ResultsTwenty-one Eyes from sixteen patients (14 eyes with previous laser in situ keratomileusis and 7 eyes with previous photorefractive keratectomy) were included. Mean postoperative spherical equivalent (SE) at 3-month was − 0.56 D ± 0.49 SD, wherein, 10 eyes (47.6%) were within ±0.50 D of the desired emmetropia and 19 eyes (90.5%) were within ±1.0 D. Mean monocular UDVA, UIVA and UNVA (logMAR) at last visit were 0.02 ± 0.07, 0.10 ± 0.10, and 0.15 ± 0.11 respectively. Three patients (19%) reported halos and glare in postoperative 3 months, two of them needed to use spectacles to improve the intermediate visual acuity. Fifteen patients (94%) reported a satisfaction score of ≥3.5 out of 4.0, without any difficulty in daily activity. Thirteen patients (81%) did not need spectacles at all distances, while the other 3 patients (19%) used spectacles for near-distance related visual activity. Mean composite score of the VF-14 questionnaire was 95.00 ± 7.29 out of 100.ConclusionsTrifocal IOL implantation after myopia excimer laser correction could restore good distance, intermediate visual acuity and acceptable near visual acuity, and provide accurate refractive outcomes as well as high spectacles independence rate.

Comparison of visual outcomes after implantation of AtLisa tri 839 MP and Symfony intraocular lenses

PurposeTo compare visual outcomes after implantation of AtLisa tri 839 MP and Symfony intraocular lenses (IOLs).MethodsAll subjects underwent sequential bilateral cataract extraction with AtLisa tri 839 MP or Symfony IOL implantation. The design is prospective case series. Each group consists of 20 patients (40 eyes). At 1 year postoperatively, the following parameters were analysed: binocular uncorrected visual acuity (log MAR): for distance (UDVA) at 4 m, for intermediate distances (UIVA) at 60, 70, 80 cm and for near (UNVA) at 40 cm, defocus curve, mesopic and photopic contrast sensitivities (CSs), spectacle independence, visual function test questionnaire modified VFQ-25), photopic phenomena and postoperative complications.ResultsIn the AtLisa tri 839 MP group, the mean binocular UNVA and UIVA were significantly better than in the Symfony group (UNVA: − 0.01 ± 0.04 vs. 0.21 ± 0.15; p = 0.000; 60 cm UIVA: − 0.01 ± 0.04 vs. 0.09 ± 0.09, p = 0.001; 70 cm UIVA − 0.05 ± 0.06 vs. 0.11 ± 0.08, p = 0.002; 80 cm UIVA − 0.01 ± 0.06 vs. 0.15 ± 0.08, p = 0.019). There were no significant between-group differences in the mean binocular UDVA and CS, with one exception: the mean binocular distance CS (18 cpd) under mesopic conditions was significantly better in the Symfony group than in the AtLisa tri 839 MP group (1.39 ± 0.22 vs. 1.17 ± 0.27; p = 0.015). The defocus curve analysis revealed significant between-group differences at vergences of 2.0 to − 4.0 D (p < 0.05), except for 2.0, 1.0, 0 and − 1.5. All subjects in AtLisa tri 839 MP group and 18 subjects (90%) in Symfony group were spectacle independent. Patients from both groups highly rated their overall vision quality in the VFQ-25 (1.67 ± 0.47 vs. 1.85 ± 0.5 in the Symfony and AtLisa tri 839 MP group, respectively, p = NS). The scores for daytime driving (1.00 ± 0.00 vs. 1.21 ± 0.36; p = 0.002), night driving (1.57 ± 0.55 vs. 2.13 ± 1.15; p = 0.027) and difficult situation driving (1.14 ± 0.31 vs. 1.53 ± 0.56; p = 0.049) were significantly better in the AtLisa tri 839 MP group than in the Symfony group. The incidence and perception level of halo and glare were significantly reduced (p = 0.00) in the Symfony group as compared to the AtLisa tri 839 MP group. The postoperative course was uneventful in all subjects.ConclusionsVisual outcomes achieved with both IOLs are comparable. In both groups, 90% of patients achieved spectacle independence. Whereas the AtLisa tri 839 MP IOL implantation was associated with slightly better intermediate distance VA and significantly better near VA, photic phenomena were less perceived by patients with Symfony IOLs.

Long-term objective and subjective outcomes following bilateral implantation of diffractive bifocal or trifocal intraocular lenses.

To evaluate and compare the objective and subjective outcomes after the bilateral implantation of a diffractive bifocal and trifocal intraocular lens. This is a case-control, single-center observational study which included 27 patients; 16 patients were implanted bilaterally with the bifocal AcrySof IQ ReSTOR+3.0D and 11 patients with the trifocal AT LISA tri 839MP. Uncorrected visual acuity at distance, intermediate, and near under mesopic and photopic conditions using ETDRS charts with 10% and 100% contrast, corrected distance visual acuity, and binocular defocus curve in photopic conditions; binocular contrast sensitivity under mesopic and photopic conditions for far and near distances were assessed. The Visual Function Questionnaire-25 questionnaire was used to assess patients' satisfaction. All the measurements were performed 6-24 months after cataract surgery. The ReSTOR group had better binocular uncorrected near visual acuity in photopic conditions with low and high contrast charts (p = 0.040 and p = 0.033, respectively), as well as in far contrast sensitivity measurement under mesopic conditions with a spatial frequency of 3 cycles per degree (p = 0.034). There was not a significant difference between the two study groups in uncorrected near, intermediate or distance vision under mesopic conditions. The AT LISA tri study group had better subjective outcomes. Both intraocular lenses restore visual acuity after cataract surgery. The ReSTOR intraocular lens provides better objective outcomes than the AT LISA tri, although the latter provides better subjective outcomes. The relevance of this study is the evaluation of both objective and subjective outcomes.

Decentration and tilt of plate-haptic multifocal intraocular lenses in myopic eyes

BackgroundTo investigate the decentration and tilt of plate-haptic multifocal intraocular lenses (MfIOLs) in myopic eyes.MethodsMyopic (axial length [AXL] > 24.5 mm) and non-myopic (21.0 mm < AXL ≤ 24.5 mm) cataract eyes were enrolled in this prospective study and randomly assigned to receive implantation of Zeiss AT LISA tri 839MP lenses (Group A) or Tecnis ZMB00 lenses (Group B). In total, 122 eyes of 122 patients were available for analysis. Decentration and tilt of MfIOLs, high-order aberrations (HOAs), and modulation transfer functions (MTFs) were evaluated using the OPD-Scan III aberrometer 3 months postoperatively. Subjective symptoms were assessed with a Quality of Vision questionnaire.ResultsNear and distance visual acuities, tilt and horizontal decentration did not differ between the two groups, postoperatively. However, myopic eyes of Group B showed greater vertical decentration than those of Group A (− 0.17 ± 0.14 mm vs. -0.03 ± 0.09 mm, respectively), particularly when the MfIOLs were placed horizontally or obliquely. Overall decentration of myopic eyes was greater in Group B than in Group A (0.41 ± 0.15 mm vs. 0.16 ± 0.10 mm, respectively). In Group B, AXL was negatively correlated with vertical decentration and positively correlated with overall decentration. No such correlations were found in Group A. Intraocular total HOAs, coma, trefoil and spherical aberrations were lower in Group A than in Group B for a 6.0 mm pupil among myopic eyes. Generally, Group A had better MTFs and fewer subjective symptoms than Group B among myopic eyes.ConclusionsPlate-haptic design of MfIOLs may be a suggested option for myopic cataract eyes due to the less inferior decentration and better visual quality postoperatively.

Visual and subjective outcomes following trifocal intraocular lens implantation in Iranian cataractous patients.

BACKGROUND:The aim of this study was to evaluate visual and refractive outcomes and quality of vision after implantation of the AT LISA tri 839MP intraocular lens (IOL).PATIENTS AND METHODS:This interventional clinical trial comprised 46 cataractous eyes of patients who underwent phacoemulsification with IOL implantation (mean age of 58.08 ± 11.01 years; range: 36–76 years old). Spherical equivalent (SE), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), corrected intermediate visual acuity (CIVA), uncorrected near visual acuity (UNVA), and corrected near visual acuity (CNVA) were measured 1, 3, and 6 months after surgery. Contrast sensitivity (CS) was measured at 6 months. Subjective quality of vision and presence of dysphotopsia by a short questionnaire were evaluated postoperatively.RESULTS:At 6 months, the mean visual acuity was 0.08 ± 0.11, 0.03 ± 0.08, 0.07 ± 0.09, 0.02 ± 0.08, 0.05 ± 0.09, and 0.02 ± 0.08 LogMAR for UDVA, CDVA, UIVA, CIVA, UNVA, and CNVA, respectively. The mean values of SE were − 0.4728 ± 0.32D. These variables improved over time, yet significant changes were detected in UDVA (P = 0.009) and SE (P = 0.0001). The mean CS value was 1.74 ± 0.08. The mean scores (0% = no symptoms; 100% = strong symptoms/unable to perform activities) for glare and halos were 7.07 ± 0.22% and 8.70 ± 0.23%, respectively. These items were reduced over time. Patients’ level of satisfaction mean score for performing activities was 96.66%.CONCLUSIONS:The AT LISA tri 839MP IOL provides excellent uncorrected distance, intermediate and near vision, and CS. This IOL showed a minimal level of photic phenomena and a high level of patient satisfaction.

Comparative analysis of the functional results after implantation of various diffractive trifocal intraocular lenses

To compare visual outcomes after implantation of two models of diffractive trifocal IOLs using various vision assessment systems. The study included 25 patients (25 eyes) who were implanted with AcrySof IQ PanOptix (TFN) and 25 patients (25 eyes) implanted with AT LISA tri 839 MP (TRI). Postoperative examination at 1 year included assessment of monocular visual acuity for far, intermediate and near distance using decimal scale, as well as LogMAR and an interactive computer program (ICP). Contrast sensitivity was assessed with the Optec 6500 device. A questionnaire was used to evaluate subjective quality of vision and the intensity of optical phenomena. Uncorrected visual acuity (UCVA) at distance, intermediate and near was better in the TFN group in comparison with the TRI group as measured with decimal scale, ICP and LogMAR. Under photopic and mesopic conditions with and without glare, at all spatial frequencies the contrast sensitivity function (CSF) was higher after implantation of TFN in comparison with TRI. The average VF-14 score was 97.2 after implantation of TFN and 96.7 after implantation of TRI. The amount of patients who required spectacle correction after the surgery was 5.5% less in the TFN group compared to the TRI group. High visual outcomes at all distances were observed in patients after implantation of both trifocal IOLs with TFN showing a slight advantage. Evaluation of the visual outcomes using various systems showed the benefits of the ICP assessment. The CSF had typical configuration with maximum value in the mid-range region and a decrease in the high-frequency range after implantation of both IOLs, however the indicators were better in the TFN group. The postoperative period was characterized by high levels of patient satisfaction and spectacle independence in both groups.

Influence of Angle κ and Higher-Order Aberrations on Visual Quality Employing Two Diffractive Trifocal IOLs.

Prospective, randomized, comparative, and controlled study to estimate the association between angle κ distance and higher-order aberrations (HOAs) with postoperative visual acuity after presbyopia-correcting IOL implantation. Forty-three eyes from 43 patients were included and randomly assigned in two groups for either AT LISA tri 839MP or Acrysof IQ PanOptix IOL implantation. The OPD-Scan III analyzer was utilized to assess the angle κ distance and higher-order aberration (HOAs). Twenty-three eyes were in the Acrysof IQ PanOptix group and 20 patients in the AT LISA tri 839MP group. The uncorrected distance visual acuity (UDVA) for the PanOptix group was 0.092 ± 0.10, whereas for AT LISA tri was 0.050 ± 0.06 (P=0.229). The uncorrected intermediate visual acuity (UIVA) for the PanOptix group was 0.173 ± 0.18, whereas for AT LISA tri, it was 0.182 ± 0.11 (P=0.669). Uncorrected near visual acuity (UNVA) was 0.068 ± 0.04 and 0.085 ± 0.07, respectively (P=0.221). Also, correlation coefficient between HOAs and the Strehl ratio for each group were −0.768 (P < 0.0001) and −0.863 (P=0.0001). Patients implanted with both trifocal IOLs showed excellent postoperative visual performance at all distances at the six-month follow-up visit. No association was found between angle κ distance and postoperative visual acuity regardless of the angle κ magnitude or the two trifocal IOLs inner optical diameter. Also, internal aberrations demonstrated a significant inverse correlation with the Strehl ratio for both trifocal IOLs.

Visual and refractive outcomes, spectacle independence, and visual disturbances after cataract or refractive lens exchange surgery: Comparison of 2 trifocal intraocular lenses

To compare the clinical performance of a hydrophobic (AcrySof PanOptix) and a hydrophilic (AT LISA tri 839MP) diffractive trifocal intraocular lens (IOL). Kaskaloglu Eye Hospital, Izmir, Turkey. Prospective case series. Patients had bilateral cataract surgery or refractive lens exchange with implantation of the hydrophobic diffractive IOL or hydrophilic diffractive IOL. The binocular corrected distance visual acuity (CDVA) at 4m, corrected intermediate visual acuity (CIVA) at 80cm and 60cm, and corrected near visual acuity at 40cm; low-contrast CDVA; spherical equivalent refraction; binocular corrected defocus curve; photic phenomena; and spectacle use were compared. The study comprised 238 eyes (119 patients). The mean CIVA at 60cm was better in the hydrophobic diffractive IOL group than in the hydrophilic diffractive IOL group (0.07 logarithm of the minimum angle of resolution [logMAR]±0.07 [SD] versus 0.22±0.10 logMAR; P<.001). The mean CIVA at 80cm was better in the hydrophilic IOL group (0.07±0.08 logMAR versus 0.17±0.09 logMAR; P<.001). Visual acuity at 1.00 diopter (D) to -2.50 D was significantly better in the hydrophobic diffractive group (P=.011 to <.001). The rate of severe and bothersome halos was higher in the hydrophilic diffractive group (P=.032 and P=.004, respectively). The percentage of patients reporting never using spectacles for intermediate vision was significantly higher in the hydrophobic group (P=.016). Both IOLs gave similar and favorable visual and refractive outcomes. The hydrophobic diffractive IOL might be more suitable for patients who require good closer intermediate viewing.

Enhancing rotational stability of toric intraocular lenses using a type 2L Cionni capsular tension ring in patients with high myopia

We present the technique used in a patient with high myopia to obtain rotational stability of a plate-haptic multifocal toric intraocular lens (IOL) (AT LISA tri toric 939MP). Both of the patient's eyes had long axial lengths and large capsular bags. The first operated eye experienced consecutive toric IOL malpositions. In the fellow eye, toric IOL alignment was preserved by implanting a type 2L Cionni capsular tension ring. This was reversely inserted so the two eyelets, which are positioned slightly anterior to the ring, pressed the IOL on the posterior capsule. This unsophisticated technical artifice provided rotational stability of the IOL, even at 12months postoperatively.

AcrySof IQ PanOptix Intraocular Lens Versus Extended Depth of Focus Intraocular Lens and Trifocal Intraocular Lens: A Clinical Overview.

AcrySof IQ PanOptix Model TFNT00 (Alcon Laboratories, Fort Worth, TX) is a 1-piece aspheric hydrophobic presbyopia-correcting intraocular lens (IOL) launched in 2015. Unlike traditional trifocal IOLs that usually have an intermediate focal point of 80 cm, the PanOptix IOL is designed to have an intermediate focal point of 60 cm (arms-length), a more natural and comfortable working distance to perform functional tasks on computers, laptops, mobiles, among others. The non-apodized PanOptix IOL uses the ENhanced LIGHT ENergy (ENLIGHTEN; Alcon Laboratories, Fort Worth, TX) optical technology that provides high (88%) utilization of light energy, low dependence on pupil size in all lighting conditions, and a more comfortable near-to-intermediate range of vision than traditional trifocal IOLs. This review provides an overview of the clinical performance of the PanOptix IOL and discusses it in the context of other commercially available trifocal IOLs, FineVision Micro F (PhysIOL, Liege, Belgium), the AT LISA tri 839MP (Carl Zeiss Meditec AG, Jena, Germany) and the extended depth of focus IOL, TECNIS Symfony (Abbott Medical Optics, Santa Ana, CA). A literature search was performed in the PubMed database to identify studies that have assessed the visual and other clinical outcomes with the PanOptix IOL. In total, 12 studies were included in this review article. Overall, the clinical evidence suggests that in general good visual outcomes, along with a high degree of spectacle independence, are achieved in patients implanted with the PanOptix, FineVision, AT LISA and Symfony IOLs. However, every MIOL has its benefits and limitations, which along with patient's needs and clinical conditions are important factors to consider while selecting an IOL to achieve best possible post-operative outcomes.

Outcomes of combining a trifocal and a low-addition bifocal intraocular lens in patients seeking spectacle independence at all distances

To assess the visual and refractive outcomes and patient satisfaction after cataract surgery in patients with a diffractive multifocal intraocular lens (IOL) with a low addition (add) power (+2.75 diopters [D]) (Tecnis ZKB00) in the dominant eye and a diffractive trifocal IOL (AT LISA tri 839MP) in the nondominant eye. Augenärzte Gerl, Kretz, and Kollegen, Head Office, Ahaus, Germany. Prospective case series. All patients had implantation of the low-add multifocal IOL in the dominant eye and a trifocal IOL in the fellow eye. Patients were evaluated preoperatively and 3months postoperatively for monocular and binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity, intermediate and near visual acuities, the binocular defocus curve, and manifest refraction. Dysphotopic phenomena were objectively evaluated and subjective patient satisfaction questionnaires administered. The study included 42 patients (84 eyes). The mean postoperative spherical equivalent was -0.06 D ± 0.57 (SD). The binocular visual acuities were 0.00±0.05 logarithm of the minimum angle of resolution (logMAR) (UDVA), 0.19±0.11 logMAR (uncorrected intermediate visual acuity at 80cm), 0.16±0.10 logMAR (distance-corrected intermediate visual acuity at 80cm), 0.11±0.09 logMAR (uncorrected near visual acuity at 40cm), and 0.08±0.09 logMAR (distance-corrected near visual acuity at 40cm). The binocular defocus curve showed a visual acuity of 0.20 logMAR or better between +0.50 D and -3.00 D. Of the patients, 92%, 92%, and 75% reported never wearing spectacles for distance, intermediate, or near distance, respectively. The mix-and-match approach seemed to provide functional visual performance at all distances while achieving spectacles independence in the majority of patients.

Comparison of postoperative visual performance between bifocal and trifocal intraocular Lens based on randomized controlled trails: a meta-analysis

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.

Effects of Bifocal versus Trifocal Diffractive Intraocular Lens Implantation on Visual Quality after Cataract Surgery.

PurposeTo compare the effects of bifocal versus trifocal diffractive intraocular lens (IOL) implantation on visual quality after phacoemulsification in patients with cataracts.MethodsEighty-eight eyes from 63 patients were analyzed. Trifocal (AT LISA tri 839MP), bifocal (AcrySof IQ ReSTOR) and bifocal (Tecnis MF ZLB00) IOLs were implanted into 53, 18, and 17 eyes, respectively. Uncorrected distance, intermediate and near visual acuity, refractive errors, contrast sensitivity, and patient satisfaction were measured at 1 week and 1 month after surgery. Refractive error was converted to a spherical equivalent and compared to predicted refraction calculated by IOL calculation formulas.ResultsUncorrected distance, intermediate, and near visual acuity did not differ significantly between groups. One month after surgery, the mean refractive errors were −0.07 diopters (D) in the AT LISA tri 839MP group, +0.18 D in the AcrySof IQ ReSTOR group, and +0.31 D in the Tecnis MF ZLB00 group (p < 0.001). The predictive accuracy of IOL calculation formulas did not differ between groups. Contrast sensitivity, satisfaction, and spectacle independence in the trifocal group were comparable with those of the two bifocal groups.ConclusionsTrifocal IOL and two different types of bifocal IOL implantation were all effective for improving visual quality, although refractive error in patients with trifocal IOL shows myopic tendencies.

Comparison of two devices to simulate vision with intraocular lenses.

IntroductionThe simulation of vision with intraocular lenses (IOLs) prior to the clinical validation is of great interest for manufacturers as well as clinicians. We have tested the influence of different IOLs on the perception of contrast using different devices.Materials and methodsA Rassow telescope and the VirtIOL have been used to assess the contrast sensitivity function (CSF) through monfocal IOL (CT Asphina 409 MP, IOL 1), multifocal IOL (AT LISA tri 839 MP, IOL 2) and extended-depth-of-focus-IOL (TECNIS Symfony ZXR00, IOL3) in 21 participants, aged between 22 and 29 years. Contrast sensitivity (CS) was tested at various spatial frequencies (3–30 cycles per degree), using the Tuebingen contrast sensitivity test.ResultsAll tested IOL reduced the CS when compared to measurements with a trial lens correction of refractive errors. The analysis of the area under the curve of the contrast sensitivity function (AUC-CSF) revealed a significant reduction compared to the trial lens correction in case the Rassow telescope was used (IOL 1: P=0.008; IOL2: P<0.001; IOL3: P<0.001) and the same was true for the VirtIOL device for IOL2 and IOL3 (IOL2: P<0.001; IOL3: P<0.001), but not for IOL1 (P=0.192). Interdevice analysis of the AUC-CSF revealed significant differences for IOL1 and IOL2 (IOL1: P=0.025; IOL2: P<0.001), while no difference was found for IOL3 (P=0.092). Bland–Altman analysis as well as intraclass correlations coefficients indicated only weak interdevice agreement for the tested IOL.ConclusionThe assessment of the interdevice analysis for the Rassow telescope and the VirtIOL device revealed only a minor agreement between the two devices. In order to investigate vision with IOLs prior to a clinical validation, the use of the VirtIOL device is recommended.

BINOCULAR IMPLANTATION OF NEW DIFFRACTIVE TRIFOCAL INTRAOCULAR LENS FOR PRESBYOPIA CORRECTION

Aim. Evaluation of the visual and functional results of bilateral implantation of the diffractive trifocal intraocular lens (IOL), the incidence of adverse optical phenomena and the degree of patient satisfaction. Methods. A prospective, open-label study included 82 patients (164 eyes) with presbyopia who underwent cataract phacoemulsification (n = 128) or refractive lensectomy (n = 36) with bilateral implantation of a new multifocal IOL AT LISA tri 839MP. The mean age of the patients was 61.2 ± 11.8 (32-84) years. The period of observation of patients was from 6 to 36 (18.3 ± 3.9) months. Results. After 1 year of follow-up, the increase in UCNVA was observed from 0.19 ± 0.17 to 0.89 ± 0.21, UCIVA from 0.18 ± 0.20 to 0.78 ± 0.17, UCDVA from 0.26 ± 0, 23 to 0.9 ± 0.12 (p

Results of Trifocal Intraocular Lenses Implantation in Patients with Cataract and Presbyopia

Purpose: to evaluate the clinical results of trifocal intraocular lenses implantation with different optical characteristics; optimization of preparation stages and intraocular correction of presbyopia. Patients and Methods. Phacoemulsification with binocular implantation of trifocal intraocular lenses (IOL) was performed in 35 patients with cataract and presbyopia. IOL AcrySof® IQ PanOptix® was implanted in 32 eyes, AT LISAtri839MP — 38 eyes. Preoperative evaluation included standard examination with surgeon’s consultation and clarification of patients’ lifestyle and vision motivations at all distances. Postoperative evaluation included measurement of refraction, visual acuity at three distances, quality and visual acuity under mesopic conditions. Proposed to use the test questionnaire, visual acuity testing tables at intermediate distances, nomograms for IOLs power calculation developed by the authors. Results. Postoperative spherical refraction was 0.17 ± 0.23D, which did not exceed 0.5D deviation from the target refraction. Uncorrected distance visual acuity ≤ 0.5 reached in 100 % of patients on the first day after surgery. Visual acuity ≤ 0.5 at intermediate distance was achieved in 34 eyes (89.5 %) of patients with implanted IOL AT LISAtri, and the same results has been recorded for near in 33 eyes (86.8 %). On the next day after surgery in the PanOptix® group, all patients monocular gave ≤ 0.6 for intermediate and near, and 96.9 % of eyes ≤ 0.5 for far. All patients from both groups (PanOptix® or LISAtri) after 6 months binocular showed visual acuity ≤ 0.8 for far, near or intermediate distances, no patient noted a need to use any spectacle correction and did not notice significant visual impairment in mesopic conditions. Conclusion. Implantation of Trifocal IOLs AcrySof® IQ PanOptix® and AT LISAtri 839MP allows patients spectacle independence and high-quality of vision in mesopic conditions. An individual approach to each patient, concomitant ophthalmopathology, general status, life style, primary refraction and precise IOLs power calculation, allows the surgeon widely to apply this technology for presbyopia intraocular correction.

Visual outcomes and patient satisfaction after bilateral implantation of a new trifocal diffractive intraocular lens

PurposeTo assess the visual outcomes, patient satisfaction and spectacle independence following implantation of new diffractive trifocal intraocular lenses. Setting2 centers (university-based practice and a private practice set up). Patients and methodsProspective nonrandomized study in which 74 AT LISA TRI 839MP and 8 AT LISA TORIC TRI 939MP IOLs implanted bilaterally in 41 patients following either cataract extraction or refractive lensectomy, follow-up was done at 1st, 2nd and 3rd months to assess the visual and refractive outcomes. Also, a questionnaire was used to assess patient satisfaction, spectacle independence and photic phenomena after the surgery. ResultsMean uncorrected monocular distance decimal visual acuity (UDVA) was preoperatively 0.35. The averages of uncorrected monocular distance/intermediate/near (UDVA/UIVA/UNVA) postoperatively were 0.90/0.87/0.91 at 3 months. 87.5% patients had SE within ±0.50 by the 3rd month. Nearly all the patients were satisfied with the surgical outcome and the reported photic phenomena by some patients were non-disturbing with noticeable high level of patient’s satisfaction by the third month. ConclusionDiffractive trifocal IOLs can provide with satisfactory visual and refractive results along with positive impact on the performance of vision-related daily activities with minimal level of non-disturbing photic phenomena to patients.

Patient outcomes following implantation with a trifocal toric IOL: twelve-month prospective multicentre study

PurposeTo evaluate clinical outcomes with a premium diffractive–refractive trifocal toric intraocular lens (IOL) over a 12-month period.MethodsMulticentre prospective clinical trial including 227 eyes of 114 patients undergoing cataract surgery with bilateral implantation of the AT LISA tri toric 939MP IOL (Carl Zeiss Meditec, Jena, Germany). One patient was implanted unilaterally. Outcome measures were: visual acuity, manifest refraction, reading performance, contrast sensitivity, defocus curve, patient satisfaction and subjective quality of vision. Alpins vector analysis was used to evaluate astigmatic changes.Results12-month follow up results of binocular uncorrected distance, intermediate and near visual acuity were ≤0.3 logMAR in 99.0%, 98.10% and 91.40% of eyes, respectively. 79.7% of eyes had a cylinder value of ±0.50 D at 12 months post-surgery. Contrast sensitivity was in the normal range at 6 months post-surgery. The defocus curve exhibited a smooth transition between far and near foci. Vector analysis showed a mean magnitude of error of −0.16 ± 0.48 D. Mean binocular distance-corrected reading visual acuity was 0.15 ± 0.13 logRAD at 6 months postoperatively. 93.3%, 89.4% and 84.6% of patients expressed satisfaction (good or very good) with distance, intermediate and near vision, respectively, 12 months after surgery. Most (≥95%) patients felt that visual disturbances, including halos, glare, focusing difficulties and depth perception, caused little or no disturbance.ConclusionsThe diffractive–refractive trifocal toric IOL, AT LISA tri toric 939MP, provides effective distance, intermediate and near visual acuity in eyes with corneal astigmatism. Patient satisfaction was high and 98.1% of patients expressed satisfaction with the IOL implanted.

Role of angle κ in visual quality in patients with a trifocal diffractive intraocular lens

To evaluate the visual quality of patients with different angle κ sizes after a trifocal diffractive intraocular lens (IOL) implantation. The Affiliated Hospital of Qingdao University, Qingdao, China. Prospective case series. Patients who had phacoemulsification with the implantation of the trifocal IOL AT LISA tri 839MP were enrolled in the study. The patients were divided into 3 groups based on the size of the preoperative angle κ. Monocular far, intermediate, and near uncorrected visual acuities were measured during a 3-month follow-up. Other outcome measurements taken were the modulation transfer function (MTF) cutoff, the Strehl ratio, and objective scatter index. All the patients completed a subjective questionnaire survey. The study comprised 89 patients (89 eyes). The 3 groups showed statistically significant differences in the incidence of glare and halo after their surgery. There were no significant differences in the following variables: uncorrected far, intermediate, and near visual acuities, MTF cutoff, Strehl ratio, and spectacle independence. There was a significant difference in the MTF cutoff and Strehl ratio between the patients with the largest and the smallest angle κ. The patients' postoperative far, intermediate, and near vision was not affected by their angle κ. However, when angle κ was greater than 0.4mm, the incidence of glare and halo increased and when it was greater than 0.5mm, patients' visual quality decreased. In clinical work, for patients with a larger angle κ, the choice to implant a trifocal IOL should be carefully evaluated.

Femtosecond laser-assisted cataract surgery with implantation of a diffractive trifocal intraocular lens after laser in situ keratomileusis: a case report

BackgroundWe report for the first time, a case of femtosecond laser-assisted cataract surgery (FLACS) with implantation of a diffractive trifocal intraocular lens (IOL) after laser in situ keratomileusis (LASIK).Case presentationA 60-year-old man underwent FLACS uneventfully 15 years after myopic LASIK. An AT Lisa tri 839MP IOL was implanted with the expectation of spectacle independence. The Haigis-L formula was chosen for calculation of the IOL power and it provided reliable results. Three months postoperatively, the uncorrected visual acuities were 0.00 logMAR for distance, 0.10 logMAR for intermediate, and 0.10 logMAR for near.ConclusionsThis case suggested that FLACS presents a feasible surgical technique for post-LASIK eyes and that implantation of trifocal IOL can achieve good visual performance in strictly selected cases after myopic LASIK.