Intraocular Lens Design Research Articles

Capsular tension ring as protective measure against in-the-bag dislocations after cataract surgery.

To assess the influence of capsular tension ring (CTR) implantation on the development of in-the-bag (ITB) dislocations after cataract surgery. Department of Ophthalmology Graz, Graz, Austria. Single-center, retrospective cohort study. The medical records of patients who underwent cataract operation between 1996 and 2017 were analyzed. Cox proportional hazards regression analysis was used to assess the influence of CTR implantation and other predisposing factors (pseudoexfoliation [PEX], age, retinitis pigmentosa, sex, zonular weakness, uveitis, high myopia, and intraocular lens design and material) on ITB dislocations. ITB dislocations were found in 111 (0.16%) of 68199 eyes (46 632 patients). In the multivariate analysis adjusted for other predisposing risk factors, a CTR implantation was associated with a lower risk of an ITB dislocation (hazard ratio [HR], 0.29; 95% CI, 0.11-0.80; P = .017). In eyes with PEX, a CTR implantation was associated with an HR of 0.16 (95% CI, 0.04-0.70; P = .015), whereas eyes without PEX had an HR of 0.80 (95% CI, 0.14-4.41; P = .793). A CTR implantation in eyes with zonular weakness resulted in a potentially lower risk (HR, 0.37; 95% CI, 0.12-1.12; P = .078). According to the dataset, implantation of a CTR was a protective measure against an ITB dislocation. Especially in patients with zonular weakness and PEX, the CTR implantation was association with a lower risk of ITB dislocations. In patients without PEX, no association was established.

Design and Optical Analysis of a Refractive Aspheric Intraocular Lens with Extended Depth of Focus

To obtain a continuous range of clear vision for pseudophakic eyes, a design of intraocular lens (IOL) with extended depth of focus (EDoF) was proposed. The IOL was optimized with a multi-configuration approach based on a pseudophakic eye model and the optical performances of the designed IOL were analyzed. The modulation transfer function (MTF) values remain above 0.2 at 50 lp/mm for object distance ranging from 0.35 m to infinity in both photopic vision and mesopic vision over a field of 4°. The optical performances remain stable when the pupil diameter changes from 2.25 mm to 5 mm. Besides, the presented theoretical analyses show the designed IOL has good optical performances for polychromatic light and corneal asphericity. The above shows that the IOL exhibits an excellent ability for pseudophakic eyes to see the object in a continuous range of distance.

Characterization of diffractive bifocal intraocular lenses

Multifocal intraocular lenses incorporate a variety of design considerations, including dimensioning of the base monofocal shape and the diffraction grating. While studying three different lens models, we present a practical approach for mathematical modelling and evaluation of these geometries. Contrary to typical lens measurement methods, non-contact measurements were performed on the Alcon SN6AD1, HumanOptics MS 612 DAY and the AMO ZMA00 lenses using a confocal microscope. Subsequent data processing includes centering, tilting correction, filtering and an algorithmic decomposition into a conic and polynomial part and the diffraction grating. Lastly, evaluation of fitting parameters and grating shape is done to allow for inferences about further optical properties. Results and analysis show the confocal microscope to be a suitable imaging method for lens measurements. The processing of this data enables the reconstruction of the annular diffraction grating over the complete lens diameter. Apodization, near addition and diffraction efficiency characteristics are found utilizing the grating shape. Additionally, near-optical axis curvature, asphericity and higher order polynomials are identified qualitatively from the reconstruction of the monofocal base form. Derived properties also include the lens optical base and addition power. By making use of the surface geometries, as well as the lens’ material and thickness, a full lens model can be created for further studies. In summary, our analytical approach enables the insight to various intraocular lens design decisions. Furthermore, this procedure is suitable for lens model creation for research and simulation.

Optical Quality Variation of Different Intraocular Lens Designs in a Model Eye: Lens Placed Correctly and in an Upside-Down Position

Introduction: Intraocular lenses (IOLs) may lose their optical quality if they are not correctly placed inside the capsular bag once implanted. One possible malpositioning of the IOL could be the implantation in an upside-down position. In this work, three aspheric IOLs with different spherical aberration (SA) have been designed and numerically tested to analyse the optical quality variation with the IOL flip, and misalignments, using a theoretical model eye. Methods: Using the commercial optical design software OSLO, the effect of decentration and tilt was evaluated by numerical ray tracing in two conditions: in their designed position and flipped with respect to the planned position (IOL is implanted upside down). The theoretical model eye used was the Atchison model eye. Seven IOL designs of +27.00 diopters were used: a lens with negative SA to correct the corneal SA, a lens to partially correct the corneal SA, and a lens to not add any SA to the cornea (aberration-free IOL). These lenses were designed with the aspherical surface located on the anterior and posterior IOL surface. A lens with no aspherical surfaces was also included. For the optical quality analysis, the modulation transfer function (MTF) was used, together with the Zernike wavefront aberration coefficients of defocus, astigmatism, and primary coma. Results: Off-centring and tilting the IOL reduced overall MTF values and increased wavefront aberration errors. With the IOL correctly positioned within the capsular bag, an aberration-free IOL is the best choice for maintaining optical quality. When the IOL is flipped inside the capsular bag, the optical quality changes, with the aberration-free IOL and the IOL without aspheric surfaces providing the worst results. With the lens in an upside-down position, an IOL design to partially correct corneal SA shows the best optical quality results in decentration and tilt, in terms of MTF and wavefront aberrations. Conclusion: The aberration-free IOL is the best choice when minimal postoperative errors of decentration or tilt are predicted. With IOL flip, the negative SA lens design is the best choice, regarding the root mean square wavefront aberrations. However, in a proper IOL implantation, the IOL designed to partially compensate the corneal SA including asphericity on its posterior surface is the better possible option, even in the presence of decentration or tilt.

Design and Optimization of Diffractive Multifocal Intraocular Lenses

Design and Optimization of Diffractive Multifocal Intraocular Lenses

Stereoacuity and Multifocal Intraocular Lenses - a Systematic Review.

Among various visual functions, stereoacuity, or the ability to perceive depth, is the most sophisticated binocular function. Many publications discuss the influence of retinal image formation by multifocal intraocular lenses on glare and contrast sensitivity, but only a few present results of testing binocular vision in patients with multifocal intraocular lenses. This article is designed to review the results of testing binocular vision in patients with multifocal intraocular lenses implanted in cataract surgery. This article was performed based on a literature review and Internet search through scientific databases such as PubMed, Scopus, Web of Science, and Google Scholar. Some reports found that patients implanted with the monofocal lens, when measured with a near addition, presented statistically significant better stereoacuity scores than those implanted with any of the multifocal intraocular lens types. When the TNO test was used for measurement, statistically significant better stereoacuity was disclosed with the refractive multifocal intraocular lens than with the diffractive-based multifocal intraocular lens design. Stereoacuity scores, even within the same types of lenses, were significantly better with the Titmus test than with the TNO test. Stereoacuity is not affected by multifocality-induced retinal blur as it is by other causes of image degradation such as small residual refractive error very early opacification of ocular media or dry eye. Multifocal intraocular lenses do not cause more functional aniseikonia than would be expected with a monofocal intraocular lens. Since stereoacuity is compromised with unilateral multifocal intraocular lens implantation bilateral implantation should be attempted.

A new inverted meniscus IOL to improve peripheral vision

AbstractThe optical quality of the images formed by the eye in the retina imposes a physical limit to our vision. For decades, the eye's optics has been mainly studied on axis, typically at the fovea where the eye has its maximum spatial resolution. However, beyond the fovea, the quality of the eye in the periphery of the retina presents special characteristics. It was discovered that the crystalline lens have a protective effect for the peripheral optics that was missed after cataract surgery when intraocular lenses were implanted. In this talk, I will revise the state of the art of this area with special emphasis in the results of my lab including the design and clinical result of a new intraocular lens with an inverted meniscus shape to improve peripheral optics in pseudophakic patients.

Evaluating the effect of ocular aberrations on the simulated performance of a new refractive IOL design using adaptive optics.

Adaptive optics (AO) visual simulators are excellent platforms for non-invasive simulation visual performance with new intraocular lens (IOL) designs, in combination with a subject own ocular aberrations and brain. We measured the through focus visual acuity in subjects through a new refractive IOL physically inserted in a cuvette and projected onto the eye's pupil, while aberrations were manipulated (corrected, or positive/negative spherical aberration added) using a deformable mirror (DM) in a custom-developed AO simulator. The IOL increased depth-of-focus (DOF) to 1.53 ± 0.21D, while maintaining high Visual Acuity (VA, -0.07 ± 0.05), averaged across subjects and conditions. Modifying the aberrations did not alter IOL performance on average.

Geometric-phase intraocular lenses with multifocality

We demonstrate a new type of multifocal and extended depth of focus (EDOF) intraocular lenses (IOLs) embedding μm-thin geometric phase (GP) lens layers. As an emerging approach for lens phase design, the GP modulated IOLs outperform conventional diffractive IOLs in multifocality while completely avoiding the clinically undesirable demand for additional surface patterns to standard monofocal IOL designs. The number of foci and light splitting ratio of the GP IOLs are adjusted by changing the number of stacked GP layers and the thickness of each layer. Bifocal and trifocal GP IOLs are fabricated by radial alignment of anisotropic orientation in UV-curable liquid crystal polymers. After characterizing the defocus image and modulation transfer function of the GP IOLs, it is expected that GP IOLs will alleviate the most common problems associated with multifocal and EDOF IOLs, blurred vision and photic phenomena caused by light scattering and posterior capsule opacification.

Positive resolution of the wound-healing response in lens epithelial cells by Ti3C2T x MXene coatings for use in accommodative intraocular lens devices

Cataract surgery removes the diseased lens of the eye replacing it with an intraocular lens, restoring visual acuity. However, accommodation, the lens’ ability to provide dynamic change in focus, is lost. A number of accommodative intraocular lens (AIOL) designs have been considered although none have provided a truly effective clinical AIOL. Two-dimensional titanium carbide (Ti3C2T x ) MXene has been used as a transparent conductive electrode within an AIOL feasibility study. Nevertheless, the potential for Ti3C2T x to repress excessive inflammation and promote wound healing following cataract surgery has not been considered. Cataract surgery can trigger chronic inflammation and epithelial-mesenchymal transition (EMT) in residual lens epithelial cells (LECs), producing a fibrotic mass across the posterior capsule known as posterior capsule opacification (PCO). With a large surface area and capacity for surface functionalisation, MXene has properties enabling a dual purpose AIOL design with an additional therapeutic role in the repression of pathways leading to PCO development. In this study, Ti3C2T x MXene was investigated to determine its impact on pathways leading to chronic inflammation and EMT using an in vitro LECs model. Ti3C2T x MXene was synthesised and characterised using UV-vis spectroscopy, dynamic light scattering and scanning electron microscopy. Changes in markers linked to inflammation and EMT in Ti3C2T x -treated LECs were measured using enzyme linked immunosorbent assays, quantitative polymerase chain reaction, scratch assay, RNA sequencing for whole-cell gene expression profiling and lipidomics analysis. Ti3C2T x significantly reduced the expression of pro-inflammatory cytokines by interleukin 1 beta primed LECs and did not advocate EMT, promoting a positive resolution of the wound healing response. This study supports the role of Ti3C2T x within an AIOL design with the potential to repress key developmental pathways leading to PCO.

How does sharp-edged intraocular lens (IOL) design compare with round-edged IOL for preventing posterior capsule opacification after cataract surgery?

How does sharp-edged intraocular lens (IOL) design compare with round-edged IOL for preventing posterior capsule opacification after cataract surgery?

Effect of anatomical differences and intraocular lens design on negative dysphotopsia.

To assess the effect of ocular anatomy and intraocular lens (IOL) design on negative dysphotopsia (ND). Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands. Ray-tracing study based on clinical data. Ray-tracing simulations were performed to assess the effect of anatomical differences and differences in IOL design on the peripheral retinal illumination. To that end, eye models that incorporate clinically measured anatomical differences between eyes of patients with ND and eyes of pseudophakic controls were created. The anatomical differences included pupil size, pupil centration, and iris tilt. The simulations were performed with different IOL designs, including a simple biconvex IOL design and a more complex clinical IOL design with a convex-concave anterior surface. Both IOL designs were analyzed using a clear edge and a frosted edge. As ND is generally considered to be caused by a discontinuity in peripheral retinal illumination, this illumination profile was determined for each eye model and the severity of the discontinuity was compared between eye models. The peripheral retinal illumination consistently showed a more severe discontinuity in illumination with ND-specific anatomy. This difference was the least pronounced, 8%, with the frosted edge clinical IOL and the most pronounced, 18%, with the clear edge biconvex IOL. These results show that small differences in the ocular anatomy or IOL design affect the peripheral retinal illumination. Therewith, they can increase the severity of ND by up to 18%.

Enhanced Monofocal Versus Conventional Monofocal Intraocular Lens in Cataract Surgery: A Meta-analysis.

To compare different outcomes of an enhanced monofocal intraocular lens (IOL) versus a conventional monofocal IOL implantation after cataract surgery. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used for abstracting data and assessing quality. Comparative studies between enhanced monofocal versus conventional monofocal IOL implantations reporting outcomes in monocular and binocular visual acuities at various distances, spectacle independence, contrast sensitivity, optical quality, and adverse effects were identified from three databases. Meta-analysis, sensitivity analysis, and subgroup analysis were performed. A total of 680 eyes implanted with an enhanced monofocal IOL (Tecnis Eyhance ICB00; Johnson & Johnson) and 647 eyes with a conventional monofocal IOL from 3 randomized controlled trials and 9 comparative studies were included. The enhanced monofocal IOL showed better monocular uncorrected intermediate visual acuity (UIVA) (mean difference [MD]: -0.11 logMAR; 95% CI: -0.12 to -0.09), binocular UIVA (MD: -0.17 logMAR; 95% CI: -0.23 to -0.11), and binocular uncorrected near visual acuity performance (MD: -0.17 logMAR; 95% CI: -0.29 to -0.04) than the conventional monofocal IOL. More patients were spectacle free at intermediate distance with the enhanced monofocal IOL (odds ratio: 12.9; 95% CI: 6.2 to 27.0). Both monocular (MD: -0.002 logMAR; 95% CI: -0.01 to 0.01) and binocular (MD: 0.01 logMAR; 95% CI: -0.02 to 0.03) uncorrected distance visual acuity revealed non-significant differences between the IOL designs. Contrast sensitivity, photic phenomenon, and adverse effects were comparable. Enhanced monofocal IOLs effectively improved unaided intermediate vision with similar distance performance relative to conventional monofocal IOLs. This was achieved without compromising the contrast sensitivity or inducing photic phenomena. [J Refract Surg. 2022;38(8):538-546.].

Effects on ocular aberration and contrast sensitivity after implantation of spherical and aspherical monofocal intraocular lens - A comparative study.

Phacoemulsification with intraocular lens (IOL) implantation is the standard of care for cataractous eyes. Monofocal IOLs are spherical or aspheric. The aspheric design of IOLs reduces the spherical and higher-order aberrations and impacts contrast sensitivity post cataract surgery. There are some studies, but data in the Indian setting with the IOLs we used is lacking. We aimed to compare the effect of implantation of spheric and aspheric foldable intraocular lenses on postoperative quality of vision, spherical aberration, and contrast sensitivity. This prospective observational study was conducted at a tertiary care hospital with an ophthalmology specialty, data collection from January 2017 to May 2018 in 100 patients. Patients meeting the inclusion criteria were selected. Their preoperative and postoperative data were collected and divided into groups based on whether spherical or aspheric IOL was implanted after cataract surgery. Variables assessed were visual acuity on days 7 and 30, spherical aberrations, and contrast sensitivity was assessed at 1-month postoperative. The mean age of the patients in this study was 64 ± 8 years with a majority of patients (60%) being females. There is no significant difference in postoperative visual acuity between the two groups. Internal SA was significantly lower (~50%) in eyes implanted with aspheric IOLs (P value = 0.004, 0.0001) compared with the spherical group. Contrast sensitivity of patients of the aspheric group was significantly better (P value <0.05). The optical design of the aspheric IOLs reduced spherical aberrations and increased contrast sensitivity.

Commentary: Aspheric intraocular lens may be the future but not always a simple solution.

Nowadays, cataract surgery is not only to achieve the vision of 20/20; rather, it demands many other qualities of vision to be fulfilled as described by Despande et al.[1] Spherical aberration is one of the varieties of higher-order aberration (HOA) in the eye. The optical design of the aspheric intraocular lens (IOLs) reduced spherical aberrations and increased contrast sensitivity as described by Despande et al.[1] As described by the authors, the crystalline lenses lose their property of negative spherical aberration to compensate for the positive spherical aberration of the eye with overall near-zero spherical aberration of the young adult eyes or very minimal spherical aberration. Wavefront technology is used nowadays more frequently by an aberrometer to map the eye before any refractive surgery to detect any aberration so that customized compensatory optical solution can be done to that eye to achieve the best possible functional vision. Patients having age-related cataracts not only suffer from a decrease in vision but also loss of contrast, especially in mesopic conditions. They did not realize it at that time due to cataracts but after cataract surgery when their contrast also improves along with their vision they are the happiest patients. Theoretically, spherical aberrations increase the depth of focus but decrease modulation transfer function at high spatial frequencies at optimum focus. Spherical aberrations, therefore, play an important role in the balance between visual acuity and depth of focus.[2] Although aspheric IOLs are replacing the spherical IOLs in our country, still PMMA rigid IOL is implanted frequently in below poverty line ( BPL) and ration cardholder patients due to the issue of affordability. Another point to be noted is that the asphericity of aspheric IOL is lost and even leads to more aberrations such as coma and coma-like effects if the IOL is slightly decentred and tilted and these aberrations occur more in aspheric IOL than in spheric IOL and monofocal IOL than multifocal IOL in such scenarios.[3] That is the reason in 1980 and 1990 there was a reluctance for aspheric IOL. However, after the evolvement of phacoemulsification, better surgery techniques such as proper rhexis size, the problems of decentration and tilt has got reduced quite a lot so more and more aspheric IOLs are implanted. The spherical aberration reduced significantly in these aspheric IOL in larger pupil aperture such as in young patients who have undergone corneal refractive surgery, especially in mesopic and scotopic conditions. Thus, the aged population with a small pupil size and having less mesopic and scotopic activity may not need the aspheric IOL. Wavefront technology is used more before corneal refractive surgery or biopics, to measure the corneal and total aberration of eyes so that customized surgery can be planned accordingly for a better functional optical outcome. The future generation of cataract surgery will not be for the recognition acuity only rather for fully functional visual outcome and aberration-free vision. With the better technique of cataract surgery, day by day such as higher competency in phacoemulsification and nowadays femto laser-assisted cataract surgery where precise capsulorhexis is done, more and more aspheric IOL will be the choice of IOL in the coming days.

Far and Near Contrast Sensitivity and Quality of Vision with Six Presbyopia Correcting Intraocular Lenses.

The objective of this prospective, randomized, double-masked study was to compare the contrast sensitivity and quality of vision of patients bilaterally implanted with the following six different presbyopia correcting intraocular lenses (IOLs): SV25T0 (n = 19), ATLISA 809M (n = 18), ATLISA TRI 839MP (n = 19), ZKB00 (n = 20), ZLB00 (n = 20) and Symfony ZXR00 (n = 20). For comparison purposes, 36 patients were implanted with a monofocal lens (ZA9003). Contrast sensitivity was assessed binocularly at distance under photopic, mesopic and mesopic plus glare conditions, and at near under photopic conditions. Quality of vision was explored in terms of photic phenomena and spectacle independence. Overall, the monofocal lens offered better contrast sensitivity, under all illumination conditions, and less occurrence and intensity of photic phenomena. Amongst the multifocal IOL (MIOL) designs, the extended depth of focus Symfony ZXR00 provided better contrast sensitivity than the other MIOLs, particularly at intermediate and high spatial frequencies. Up to 40% and 50% of patients implanted with MIOLs reported glare and halos, respectively. The SV25T0 resulted in less occurrence and intensity of halos. The evaluation of photic phenomena and contrast sensitivity under different illumination conditions may reflect real-life, visually challenging situations, and thus provide insightful information to assist ophthalmic surgeons when selecting the best intraocular lens for their patients.

Intraocular Lens Optic Power Calculation on “Short” Eyes. A Review

In recent years, due to advances in surgical technique, instruments and design of intraocular lenses (IOLs), patient expectations of cataract surgery have increased significantly, often matching those after refractive interventions. A number of factors affect postoperative visual acuity, including the presence of concomitant pathology in patients, the experience of the surgeon, the choice of IOL model and other factors. In the presence of “short” eyes, with an axial length of less than 22 mm, the formulas available in the arsenal for calculating the optical power of the IOL are less accurate than for eyes with normal sizes, which is of great difficulty for the surgeon. The most important factors include the choice of model and calculation of IOL optic power associated in case of failure with patient dissatisfaction with the treatment. The review discusses the definitions of the concepts of hyperopia, microphthalmos and nanophthalmos. The sources of errors are presented when choosing a formula for calculating the IOL optic power, including the use of various instruments for measuring axial length and other parameters of the eye. The necessity of optimizing the IOL constants for “short” eyes is given. The effectiveness of the main currently used formulas is considered, including Hoffer Q, Haigis, Holladay 1, Holladay 2, SRK / T, Barrett Universal, Super Formula, Olsen, T2, Hill-RBF, Kane. Progress in lens disease surgery does not stand still and is aimed at improving diagnostic equipment and standardizing and synchronizing various types of biometers, increasing the number of variables in formulas for calculating the IOL optic power, further standardizing diopter power in the manufacturing of IOLs, and the need to develop a unified formula for calculating optical power Artificial Intelligence IOL with the possibility of its constant access to a huge array of preoperative research data manhole and postoperative assessment of results. Management of patients with an axial length of less than 22.00 mm remains a challenge for ophthalmic surgeons, given the difficulties encountered in choosing an IOL and the complications of surgery. The available formulas for calculating the IOL optic powerneed to be adjusted for this group of patients.

Research Progress Concerning a Novel Intraocular Lens for the Prevention of Posterior Capsular Opacification.

Posterior capsular opacification (PCO) is the most common complication resulting from cataract surgery and limits the long-term postoperative visual outcome. Using Nd:YAG laser-assisted posterior capsulotomy for the clinical treatment of symptomatic PCO increases the risks of complications, such as glaucoma, retinal diseases, uveitis, and intraocular lens (IOL) pitting. Therefore, finding how to prevent PCO development is the subject of active investigations. As a replacement organ, the IOL is implanted into the lens capsule after cataract surgery, but it is also associated with the occurrence of PCO. Using IOL as a medium for PCO prophylaxis is a more facile and efficient method that has demonstrated various clinical application prospects. Thus, scientists have conducted a lot of research on new intraocular lens fabrication methods, such as optimizing IOL materials and design, and IOL surface modification (including plasma/ultraviolet/ozone treatment, chemical grafting, drug loading, coating modification, and layer-by-layer self-assembly methods). This paper summarizes the research progress for different types of intraocular lenses prepared by different surface modifications, including anti-biofouling IOLs, enhanced-adhesion IOLs, micro-patterned IOLs, photothermal IOLs, photodynamic IOLs, and drug-loading IOLs. These modified intraocular lenses inhibit PCO development by reducing the residual intraoperative lens epithelial cells or by regulating the cellular behavior of lens epithelial cells. In the future, more works are needed to improve the biosecurity and therapeutic efficacy of these modified IOLs.

One-Year Outcomes of Modified Technique for Scleral Fixation of a Three-Piece Intraocular Lens Without Conjunctival Opening.

PurposeThis study aimed to present the 1-year follow-up of a modified technique for scleral fixation of three-piece intraocular lens (IOLs) without conjunctival incision.Materials and MethodsA retrospective chart review of a consecutive series of 10 eyes of nine patients who underwent scleral IOL fixation using the modified technique was performed. Data were collected 1 year after surgery for all patients.ResultsThe range of follow-up time was between 1 year and 31 months. At the last follow-up point, the IOL was well-positioned and the visual acuity was good (as limited by primary diseases). Short-term complications included pupillary IOL capture (n = 1) and decreased intraocular pressure (n = 1), and no long-term complications were observed.ConclusionOutcome data support this technique as a viable option for the management of secondary IOL fixation with flexible usage of more designs of IOLs.

Visual and Refractive Outcomes Following Exchange of an Opacified Multifocal Intraocular Lens.

PurposeTo assess the visual and refractive outcomes following exchange of an opacified multifocal intraocular lens (IOL).Patients and MethodsA consecutive series of 37 eyes (31 patients) that underwent IOL exchange between November 2015 and May 2021 were included in this study. The indication for surgery in all cases was opacification of a multifocal IOL. Outcome measures included design and anatomical location of the secondary IOL, intraoperative and postoperative complications, visual acuity and refractive accuracy.ResultsAn opacified Lentis Mplus multifocal IOL was explanted from all eyes and replaced with a monofocal IOL in 21 eyes (57%) and multifocal IOL in 16 eyes (43%). Secondary IOLs were implanted in the capsular bag or sulcus or were iris-fixated. IOL exchange was performed at a mean interval of 7 years after the primary surgery. Anterior vitrectomy was required for vitreous prolapse in 9 eyes (24%). Mean corrected distance visual acuity (CDVA) postoperatively was −0.02 ± 0.08 logMAR for eyes with a monofocal secondary IOL and 0.02 ± 0.08 logMAR for eyes with a multifocal secondary IOL. Mean refractive prediction error was −0.57 ± 0.67 D in the multifocal-monofocal group and −0.33 ± 0.59 D in the multifocal–multifocal group.ConclusionAn opacified multifocal IOL can be exchanged for a monofocal or multifocal IOL, depending on available capsular support and the patient’s desired refractive outcome. Vitreous prolapse requiring anterior vitrectomy is the most common intraoperative complication. An improvement in visual acuity and a low postoperative complication rate were achieved in this cohort of patients.