Multifocal Intraocular Lens Research Articles

Rotational stability of monofocal and diffractive multifocal toric intraocular lens with identical design and material: a propensity score based prospective comparative study

PurposeTo compare the rotational stability of a monofocal and a diffractive multifocal toric intraocular lens(IOLs) with identical design and material.MethodsThis prospective study enrolled patients who underwent plate-haptic toric IOL (AT TORBI 709 M and AT LISA 909 M) implantation. Propensity score matching (PSM) was performed to balance baseline factors. Follow-up examinations were conducted at 1 h, 1 day, 3 days, 1 week, 2 weeks, 1 month, and 3 months postoperatively. A linear mixed model of repeated measures was used to investigate the changes in IOL rotation over time. A 2-week timeframe was utilized to assess differences in IOL rotation between the two groups.ResultAfter PSM, a total of 126 eyes were selected from each group for further analysis. Postoperatively, the time course of IOL rotation change in the two groups remained consistent, with the greatest rotation occurring between 1 h and 1 day postoperatively. At the 2-week postoperative mark, the monofocal toric IOL exhibited a higher degree of rotation compared to the multifocal toric IOL (5.40 ± 7.77° vs. 3.53 ± 3.54°, P = 0.015). In lens thickness(LT) ≥ 4.5 mm and white-to-white distance(WTW) ≥ 11.6 mm subgroups, the monofocal toric IOL rotated greater than the multifocal toric IOL (P = 0.026 and P = 0.011, respectively).ConclusionThe diffractive multifocal toric IOL exhibits superior rotational stability compared to the monofocal toric IOL, especially in subgroups LT ≥ 4.5 mm and WTW ≥ 11.6 mm. Moreover, the time course of IOL rotation change is consistent for both, with the maximum rotation occurring between 1 h and 1 day postoperatively.

Monovision versus multifocal intraocular lens implantation in cataract patients: a systematic review and meta-analysis

Abstract
 Introduction & Objectives : Modern cataract surgery technique entails replacing the crystalline lens with an artificial intraocular lens (IOL). While the standard monofocal IOL implantation with monovision technique has been cost- effective and provided patients with good visual acuity, multifocal IOLs present the prospect of spectacle-free vision despite various adverse outcomes. It remained contentious whether multifocal IOLs were superior to monovision. Our review provide an up-to-date assessment of monovision vs. multifocal IOL implantation's visual acuity and spectacle independence following cataract surgery.
 Methods : A systematic search was performed in April 2023 on six databases (Medline, SCOPUS, Proquest, EBSCO, Embase, and PubMed). Studies were extracted for the following outcome of interest: monovision, multifocal intraocular lens, spectacle independence, and visual acuity. All studies published up to April 2023 were reviewed. Cochrane risk of bias tool (RoB 2) was used to screen studies for risk of bias where appropriate. A meta-analysis was done to quantify any reported quantitative data.
 Results : Ten studies were identified. Pooling analysis for uncorrected binocular distance visual acuity and binocular uncorrected near visual acuity showed no difference between monovision vs. multifocal IOL (SMD 0,31; 95% CI -0,21 to 0,82 and SMD 0,41; 95% CI -0,58 to 1,40, respectively). Spectacle independence showed monovision was inferior to multifocal IOL (OR 0,22; 95% CI 0,08 to 0,61; heterogeneity I2=75%).
 Conclusion : Current evidence showed that multifocal IOL had comparable visual acuity to monovision with slightly higher likelihood of being spectacle-free. Despite that, monovision can be an efficacious and affordable option to be implemented in countries with high cataract burden.

MONOVISION VERSUS MULTIFOCAL INTRAOCULAR LENS IMPLANTATION IN CATARACT PATIENTS:A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: With the aim to increase spectacle independence, recent approaches to repair cataracts include the implantation of premium intraocular lenses (IOLs), such as multifocals. Another approach is monovision techniques achieved by monofocal IOL implantation, which is more cost-effective, although it has the same good outcome as multifocal IOLs. This meta-analysis aimed to compare monovision versus multifocal IOL implantation in cataract patients. Method: Systematic search was performed in April 2023 on six databases (Medline, SCOPUS, Proquest, EBSCO, Embase, and PubMed). Studies were extracted for the following outcome of interest: monovision, multifocal intraocular lens, spectacles independence, visual acuity. All studies published up to April 2023 were reviewed. Cochrane risk of bias tool (RoB 2) and The Risk Of Bias In Non-randomized Studies – of Interventions (ROBINS-I) was used to screen studies for risk of bias where appropriate. A meta-analysis was done to quantify any reported quantitative data. Result: Ten studies satisfying the inclusion criteria were included. Pooling analysis for BCVA and BNVA showed no difference between monovision vs multifocal IOL (95% CI at -0,10 to 0,73; I2=79% (p=0,14) and 95% CI at -0,27 to 1,37; I2=94% (p=0,19), respectively). Spectacle independence showed monovision was inferior to multifocal IOL (RR 0,53; 95% CI at 0,34 to 0,82; I² 83% (p=0,004)). Conclusion: Current evidence showed monovision was comparable to multifocal IOL in terms of visual acuity. While multifocal IOL achieved more spectacle-free patients than monovision, many patients in the monovision group also achieved spectacle-free condition. Keywords: cataract, monovision, multifocal intraocular lens, visual acuity, spectacle independence.

Economic evaluations in cataract surgery: a narrative review.

Economic evaluations are tools for assessing emerging technologies and a complement for decision-making in healthcare systems. However, this topic may not be familiar for doctors and academics, who may be confused when interpreting the results of studies using these tools. Cataract is a disease which has received special attention in healthcare systems due to its high incidence, the great impact that it could have on patients' quality of life, and the fact that it can be definitively solved in almost all cases through cataract surgery. Historically, economic evaluations in cataract surgery have been conducted for many purposes by simply assessing whether the surgery is cost-effective for specific questions related to the implantation of multifocal intraocular lenses, surgical techniques, optimizing assessments, preventing diseases or complications, etc. Moreover, although there are systematic reviews about cataract surgery and narrative reviews introducing the concept of economic evaluations, as far as we know, no previous study has been conducted that synthesizes and integrates evidence coming from both fields. Thus, the purpose of this narrative review is to introduce doctors and academics to economic evaluation tools, to describe how these have been historically applied to cataract surgery, and to provide special considerations for the correct interpretation of economic studies.

Effect of residual sphere on uncorrected visual acuity and satisfaction in patients with monofocal and multifocal intraocular lenses.

To assess the effect of residual sphere on vision and satisfaction in pseudophakic patients. Private clinics, United Kingdom. Retrospective case series. A multivariate model evaluated the effect of 1-month residual sphere on outcomes of pseudophakic patients. Odds ratios (ORs) were calculated to assess the relative risk of not achieving ≥20/20 monocular uncorrected distance visual acuity (UDVA), ≥20/50 uncorrected near visual acuity (UNVA), and not being satisfied with vision. ORs were assessed for residual sphere -1.00 to +1.00 diopter (D) in quarter-diopter steps, using 0.00 D as a reference. The analysis included 38 828 multifocal and 11 571 monofocal intraocular lenses (IOLs). The residual myopic sphere ≤-0.25 D and hyperopic sphere ≥+0.50 D had a clinically meaningful effect on UDVA. Although monofocal IOLs had an improvement in UNVA with every additional 0.25 D of myopia, the change in ORs with increasing myopia was not significant for multifocal IOLs. The mean improvement in UNVA comparing eyes with 0.00 D and -1.00 D sphere was 0.26 logMAR for monofocal and 0.03 logMAR for multifocal IOLs. Low near-addition IOLs had a slightly higher gain in UNVA with increasing myopia, but the gain was not as substantial as with monofocal IOLs. The effect of ametropia on satisfaction was more pronounced for multifocal IOLs. For every 0.25 D of residual myopia, there was >25% increase in dissatisfied patients. Although myopia improved UNVA in eyes with monofocal IOL, multifocal IOLs did not benefit from residual myopia. Multifocal IOL patients desiring distance vision should be targeted closest to emmetropia, even if it means targeting slight hyperopia.

The effect of trifocal and extended-depth-of-focus intraocular lenses on optical coherence tomography parameters.

Optical properties of commonly used multifocal and extended-depth-of-focus (EDOF) intraocular lenses (IOLs) can induce artifacts or changes in optical coherence tomography (OCT) measurements. Our purpose was to investigate the possible effects of different IOLs on peripapillary and macular OCT parameters. The preoperative and postoperative third-month peripapillary OCT and ganglion cell analysis (GCA) parameters of patients having monofocal (Alcon IQ), multifocal (PanOptix), or EDOF (Vivity) IOL implanted during cataract surgery were compared. Sixty-four eyes of 64 patients were included (21 monofocal, 24 multifocal, and 19 EDOF). Although all OCT image qualities increased postoperatively, only GCA image quality changes in the monofocal and multifocal groups reached statistical significance. Most peripapillary retinal nerve fiber layer (RNFL) and GCA parameters were similar preoperatively and postoperatively. The superior RNFL thickness in the monofocal group and the temporal RNFL thickness in the EDOF group were higher postoperatively ( P = 0.04 and P = 0.02, respectively). Most GCA and RNFL value changes between preoperative and postoperative measurements were similar between groups. In the parameters that changed, postoperative values were higher in the monofocal group ( P = 0.02 for minimum ganglion cell layer and inner plexiform layer, P = 0.04 for average RNFL). Trifocal and EDOF IOLs do not seem to have a negative effect on OCT parameters.

Long-Term Refractive Outcomes and Visual Quality of Multifocal Intraocular Lenses Implantation in High Myopic Patients: A Multimodal Evaluation.

To perform a multimodal assessment of refractive outcomes and quality of vision (QoV) in patients with high myopia submitted to multifocal intraocular lens (IOL) implantation. Retrospective study that included consecutive eyes with high myopia (axial length [AL] >26.00mm) submitted to multifocal IOL implantation between January 2014 and February 2020. Minimum follow-up time was 3 years. QoV was evaluated with the Objective Scatter Index (OSI) and the Modular Transfer Function (MTF) by HD Analyzer®. Two QoV questionnaires were applied to patients in which both eyes were included: the McAlinden and the Catquest-9 SF. We included 50 eyes (28 patients). The mean follow-up time was 5.4±1.0 years. Comparing to month 1 after surgery, at the last follow-up visit, there was a decrease in the uncorrected visual acuity (0.14±0.13 vs 0.08±0.09 LogMAR, p=0.024), a negative increase in the spherical equivalent (-0.31±0.60 vs -0.02±0.20, p=0.006) and no changes in the best-corrected visual acuity (p>0.999). An uncorrected near visual acuity of at least J2 was achieved in 89% of eyes one month after surgery and in 91% of eyes at the last follow-up visit (p=0.829). At the last follow-up, the mean OSI was 5.1±1.8 and the mean MTF was 17.5±10.6. Some degree of near vision difficulty was reported by 91% of patients, and 74% of patients reported photic phenomena (halos, glare, starbursts). However, most patients reported that these symptoms caused none to little bothersome. At the last follow-up, 87% of patients were at least fairly satisfied with the surgery. Even after a mean follow-up time of 5 years, patients maintained good uncorrected visual acuity. Even though most patients experienced some degree of near vision difficulty and visual symptoms, globally, our patients were satisfied with their current vision, and the experienced symptoms did not have a significant impact on their daily lives.

Long-term Prevalence of Opacification of a Hydrophylic Acrylic Rotationally Asymmetric Refractive Multifocal Intraocular Lens.

To determine the prevalence of opacification of a hydrophylic intraocular lens (IOL) with hydrophobic coverage and the percentage of explantations required, determining possible risk factors associated with these opacifications. This ambispective study enrolled 575 eyes of 296 patients (age 36 to 87 years) that underwent cataract surgery between 2010 and 2017 with implantation of different models of Lentis Mplus IOLs: LS-312-MF30, LS-313-MF15, LS-313-MF30, LU-313-MF30, and LU-313-MF30T (Oculentis GmbH). Visual, refractive, and slit-lamp biomicroscopic changes were evaluated in a long-term follow-up. The percentage of cases with IOL opacification and the percentage of cases in which IOL explantation was required due to such opacifications were calculated at each visit. Five of the explanted IOLs from this series could be analyzed by scanning electron microscopy (SEM-EDX). IOL opacification developed in 63 eyes (11.0%). With 95% confidence, the prevalence of IOL opacification was between 842 and 1,401 cases per 10,000 eyes. The time elapsed between surgery and the presence of IOL opacification ranged between 0 and 9.3 years (mean: 4.7 ± 2.2 years). No significant differences in terms of IOL opacification rate were found according to gender (P = .378). No significant differences were found in arterial hypertension, diabetes, hypothyroidism, or hyperthyroidism rates between eyes with or without IOL opacification (P ≥ .053). IOL explantation was needed in 9 eyes (1.57%). SEM-EDX analysis confirmed the presence of rough areas on the IOL surface containing different components, such as calcium, phosphorous, copper, or nitrogen. The prevalence of opacification with time in Lentis Mplus IOLs is high, with no systemic risk factors associated with this complication, suggesting that it may be attributable to the material and/or the manufacturing process. [J Refract Surg. 2024;40(2):e98-e107.].

Screening of positive dysphotopsia before multifocal intraocular lens implantation.

To assess the photic phenomena (PP) and positive dysphotopsia in candidates for presbyopia or cataract surgery and to evaluate their relationship with cataract grading systems. Retrospective observational. Monocular data for 82 subjects measured during the preoperative screening were retrospectively retrieved from our database. The evaluated variables consisted of two methods for PP measurement: light distortion index (LDI) and parameters obtained from a simulator, both of which were combined with subjective bother related to PP. The cutoff for LDI that better predicted patients passing from slightly to moderately bothersome was estimated. The relationships between LDI and the following objective cataract grading methods were also assessed: objective scatter index (OSI), dysfunctional lens index (DLI), and Pentacam Nucleus Staging (PNS). LDI was the best method for measuring PP, which showed a significant correlation with the bothersome question (rho = 0.34, P = 0.002) and also with OSI (rho = 0.67, P < 0.0005), DLI (rho = -0.29, P = 0.007), and PNS (rho = 0.48, P < 0.0005). The number/percentage of patients who found it bothersome was as follows: "Not at all" (18/22%), "Slightly" (41/50%), "Moderately" (15/18.3%), and "Very" (8/9.7%). The cutoff value that predicted the transition from slightly to moderately bothersome was ≥15.20% according to LDI, which could be estimated with the following values for grading: ≥2.8 for OSI, ≤7.6 for DLI, and ≥2 for PNS. Patients reporting moderately or higher bothersome levels in the preoperative period and with LDI <15.20%, <2.8 for OSI, >7.6 for DLI, and <2 for PNS might deserve special attention in the multifocal intraocular lens selection.

Changes in Chord Mu (µ) Length Before and After Cataract Surgery

Aim: Comparison of chord  length, a potential marker that may gain importance especially in multifocal lens implantation, before and after phacoemulsification surgery and intraocular lens (IOL) implantation in patients with cataracts. Methods: This retrospective study included 33 eyes of 33 patients who underwent phacoemulsification surgery between December 2022 and February 2023. Corneal topography (Pentacam HR, Oculus, Wetzlar, optikgerate GmbH) was performed on each patient before and after surgery. The values obtained before and at least 3 months after surgery were compared using the Student-t test. Results: There were 18 (54.5%) males and 15 (45.5%) females among the 33 patients who participated in the study. The average age was 67.27 ± 10.93 years. The postoperative mean chord μ lenght was significantly lower than the preoperative mean chord μ lenght (p=0.002). Additionally, the mean postoperative pupil size was significantly lower than the mean preoperative pupil size (p=0.000). There is a weak positive relationship between the change in chord μ length and the change in pupil size, but this relationship is not statistically significant (p&gt;0.05). No statistically significant relationship was found between any of the other binary variables. Conclusion: Centralization is crucial in refractive surgery and multifocal IOL implantation to prevent high-order aberrations and photic phenomena. Therefore, it seems useful for surgeons to be familiar with chord μ measurements, especially regarding surgical preparation. It should be considered that changes in chord mu values may influence the development of photic phenomena. A decrease in chord mu after phacoemulsification may assist the surgeon in the preoperative decision-making process in patients at risk of photic phenomena or in patients with borderline values.

Multifocal intraocular lens implantation in children with unilateral congenital cataracts.

To evaluate the vision recovery, reconstruction of binocular visual function, and influencing factors after multifocal intraocular lens implantation in children with unilateral congenital cataracts. University hospital. Prospective clinical study. In the prospective clinical study, 55 children aged 3 to 14 with unilateral congenital cataracts received multifocal intraocular lenses (TECNIS ZMB00) posterior optic capture from 2019 to 2022. Corrected distance visual acuity (CDVA; 5 m), distance-corrected intermediate visual acuity (DCIVA; 66 cm), distance-corrected near visual acuity (DCNVA; 33 cm), stereoscopic vision, visual quality (objective scatter index [OSI] and modulation transfer function [MTF]), axial length (AL), keratometry (K), and contrast sensitivity (CS), as well as postoperative occlusion compliance were evaluated before and after surgery. At the final follow-up, 90.91% (50/55) patients showed significant improvement in visual acuity (VA) after surgery. CDVA, DCIVA and DCNVA were 0.23 ± 0.17, 0.39 ± 0.15, and 0.44 ± 0.15 logMAR, respectively. 69.09% (38/55) patients achieved good VA (better than 0.3 logMAR).52.76% (25/48) patients had a positive Titmus test. OSI and MTF were 1.24 ± 0.91 and 42.45 ± 12.30, respectively. 73.68% (28/38) of the patients (better than 0.3 logMAR) underwent strict occlusion therapy. Postoperative VA is correlated with preoperative CDVA ( r = -0.829, P < .001), corneal astigmatism ( r = 0.384, P = .036), △AL (difference between the cataract eyes and contralateral eyes, r = -0.490, P = .006), and occlusion compliance ( r = -0.806, P < .001). Multifocal intraocular lens implantation could obtain relatively satisfactory VA (CDVA, DCIVA and DCNVA) and the binocular visual function of children with unilateral congenital cataracts. Postoperative VA is related to preoperative VA, corneal astigmatism, △AL, and occlusion compliance.

Vitamin A deficiency with nyctalopia after bilateral cataract surgery with multifocal intraocular lenses

Introduction: The purpose of this case study was to report an unusual case of vitamin A deficiency (VAD) with nyctalopia that was diagnosed after bilateral cataract surgery with multifocal intraocular lenses (IOLs). Patient and Clinical Findings: After cataract surgery with multifocal IOLs, a 66-year-old man developed progressive intolerable night vision symptoms, requesting IOL exchange. Diagnosis, Intervention, and Outcomes: Only careful history and investigation revealed the cause to be VAD secondary to celiac disease, rather than lens-related. The patient was commenced on parenteral vitamin A resulting in a complete resolution of nyctalopia. Conclusions: To our knowledge, this is the only reported case of VAD diagnosed in this context. We reflect on the importance of thorough history taking, particularly in patients referred for cataract surgery by their optometrist, where the provided medical history may be incomplete.

Visual and refractive outcomes of opposite clear corneal incision combined with rotationally asymmetric multifocal intraocular lens implantation.

To evaluate the visual and refractive outcomes of astigmatic cataract patients following opposite clear corneal incision (OCCI) combined with rotationally asymmetric multifocal intraocular lens (IOL) implantation. Department of Ophthalmology, Zhongshan Hospital (Xiamen), Fudan University, People's Republic of China. Retrospective cohort study. This study comprised 58 cataract eyes of 54 patients with corneal astigmatism who underwent phacoemulsification and rotationally asymmetric multifocal IOL implantation which received either OCCI (OCCI group) or a single clear corneal incision (SCCI group). The follow-up period was 3 months after surgery. Distance, intermediate and near visual acuity, refractive outcomes, and corneal anterior keratometry were compared between the two groups. Vector analysis was used to evaluate astigmatism correction. Three months after surgery, the distance, intermediate and near visual acuity, and sphere remained comparable between the two groups, but a significant difference was detected in residual astigmatism and anterior corneal keratometric astigmatism. In the OCCI group, the residual astigmatism and keratometric astigmatism were -0.60 ± 0.29 D and 0.59 ± 0.28 D, respectively, which were lower than those in SCCI groups (-1.18 ± 0.47 D and 1.15 ± 0.45 D, both p < 0.05). In vector analysis, the difference vector (DV), angle of error (AoE), absolute AoE, index of success (IoS) and correction index (CI) were statistically significantly different between the two groups (p < 0.05). OCCI combined with rotationally asymmetric multifocal intraocular lens implantation showed predictable and desirable efficacy in treating cataract patients with astigmatism.

Study of wavefront aberration after multi-focal intraocular lens implantation

Study of wavefront aberration after multi-focal intraocular lens implantation

Comparative Analysis of Tolerance to Experimentally Induced Astigmatism with Three Types of Multifocal Intraocular Lenses.

The effect of residual astigmatism and its axis on distance and near visual acuities (VAs) with multifocal intraocular lenses (IOLs) has not been studied extensively. This study compared the tolerance to experimentally induced residual astigmatism among bifocal, trifocal, and extended depth-of-focus (EDOF) IOLs. This retrospective, comparative study included 70 eyes of 70 patients implanted with bifocal, trifocal, or EDOF IOLs. Distance and near VAs were assessed with experimentally induced astigmatism by placing positive cylindrical lenses in increments of 0.50 diopters to 2.00 diopters at 90° and 180° axes over the best distance correction. Both distance and near VAs worsened with increasing magnitudes of experimentally induced astigmatism except in the EDOF group, in which the near VA remained within a clinically acceptable limit, ie, within one line from the best corrected VA under all ranges of experimentally induced astigmatism. Furthermore, the EDOF group showed the highest astigmatic threshold for losing VA lines following experimental astigmatic induction at both distance and near. The distance VA was generally better at with-the-rule (WTR) than against-the-rule (ATR) astigmatism for all three IOL groups. On the other hand, the near VA was generally better at WTR than ATR astigmatism in the bifocal group, comparable between WTR and ATR astigmatism in the trifocal group, and generally better at ATR than WTR astigmatism in the EDOF group. The EDOF IOL demonstrated the highest tolerance to experimentally induced astigmatism at both distance and near. VA was generally less affected by WTR astigmatism than ATR astigmatism, especially at distance. We proposed the residual astigmatism thresholds for clinically acceptable VA reduction in all three IOL groups.

Clinical Outcomes of a Trifocal Versus an Extended Depth of Field Intraocular Lens in Chinese Patients With Cataract: A Prospective Cohort Study.

Purpose: To compare the standard outcomes between the PanOptix and Symfony multifocal intraocular lenses (MIOLs) in Chinese patients. Methods: This prospective observational cohort study enrolled patients with cataracts between April 2021 and December 2021 at Xiamen Eye Center Affiliated to Xiamen University. The patients were grouped in the PanOptix (TIOL group) and Symfony (EDF group) according to the IOLs implanted. Uncorrected distant, corrected distance, binocular uncorrected intermediate, and near visual acuity (UNVA), distance-corrected intermediate and near VA (DCNVA) , defocus curve, spectacle independence, contrast sensitivity (CS), and visual disturbances were evaluated after 3 months. Results: Forty patients (80 eyes) were enrolled in the study (20/group). Three months after the operation, UNVA (0.13 ± 0.16) and DCNVA (0.08 ± 0.08) were better in the TIOL group than in the EDF group (0.22 ± 0.08 and 0.22 ± 0.08, respectively, p=0.003 and p < 0.001, respectively). The TIOL group achieved a better-than-0.15-logMAR VA from +0.5 D to -2.5 D (40 cm). VAs of the TIOL group from -1 D (100 cm) to -4 D (25 cm) were better than in the EDF group (p < 0.05). There were no significant differences in the intermediate and far vision outcomes (p > 0.05). Total near-vision spectacle independence was higher in the TIOL group (80%) than in the EDF group (50%) (p=0.039). Conclusion: Compared with EDF, TIOL leads to better near-vision outcomes without significant differences for intermediate and distant vision outcomes. Trial Registration: ClinicalTrials.gov identifier: ChiCTR2100044558.

Relentless bilateral accommodation spasm in an adolescent treated with clear lens extraction

Introduction: Pathologic accommodation spasm occurs when persistent contraction of the ciliary muscle of the eye induces pseudomyopia. The purpose of this report was to describe the case of an adolescent with recurrent ciliary spasm, refractory to medical treatment for several years. Patient and Clinical Findings: A 10-year-old girl was evaluated because of complaints of decreased visual acuity (VA) and frequent headaches. Diagnosis, Intervention and Outcomes: The diagnosis of pseudomyopia due to accommodation spasm was established. No organic causes were detected. She started treatment with cycloplegics, which were successively titrated at different doses, along with the use of spectacles, over the following years. After 7 years of follow-up, the lack of efficacy of treatment and intolerance to its side effects demanded further action, so a clear lens extraction was performed, with the implantation of continuous focus transition multifocal intraocular lenses. Her final uncorrected distance VA was 6/6 in each eye, with good intermediate vision and J1 near vision with +2.00 addition. Conclusions: In severe cases of ciliary spasm, medical therapy and spectacle prescription may not be sufficient to control the disease. Intraocular lens implantation may be the only remaining therapeutic option to provide quality of life to the patient.

Clinical Application of Multifocal Intraocular Lens Implantation in Patients with High Myopia and Cataract

Clinical Application of Multifocal Intraocular Lens Implantation in Patients with High Myopia and Cataract

Aberracje wyższego rzędu jako coraz istotniejszy parametr podczas kwalifikacji pacjenta do operacji usunięcia zaćmy

Higher order aberrations are complex optical errors that affect the quality of vision, especially in low light conditions. The article discusses the impact of higher order aberrations on the choice of intraocular lens during cataract removal surgery. These aberrations affect the patient’s vision quality after the surgery, and their analysis allows for a more precise selection of intraocular lens, increasing the chances of achieving better clinical outcomes. The article covers the main types of higher order aberrations and their impact on the choice of intraocular lens. The number of higher order aberrations changes with the patient’s age and can be the cause of suboptimal outcomes after the implantation of multifocal IOLs. Preoperative examination of the patient, taking into account higher order aberrations, is crucial for obtaining satisfactory postoperative results. Further research on higher order aberrations is essential for the development of technologically advanced intraocular lenses.

BOLD fMRI in patients before and after multifocal intraocular lens implantation

Background. In practical ophthalmology during cataract surgery, patients are increasingly being implanted with multifocal intraocular lenses (mfIOLs), which form several foci on the retina. The appearing of new factors creates conditions for human neuroadaptation, the parameters of which can be assessed using a modern research method – functional magnetic resonance imaging (fMRI). Purpose: to determine the change in the nature of the activation of the visual brain cortex in response to stimulation after surgery for the implantation of a multifocal artifi cial lens. Materials and methods. The study included patients with cataract (n = 22), who underwent structural neuroimaging and BOLD fMRI to assess neuronal activity before and after mfIOL implantation. The Gabor element was used as a stimulus for performing BOLD fMRI (unilluminated and ill uminated versions). fMRI data (positive BOLD effect) were processed using the SPM 12 software package in the Matlab R2017a environment. Evaluation of the research results was carried out at the individual and group levels. Results. When evaluating individual results after mfIOL implantation, patients show more local activation of the cerebral cortex, gravitating towards the area of the spur sulcus, while before surgery, the cortical response is more diffuse. In a group analysis in patients after mfIOL implantation, the total volume of the activation cluster of the cerebral cortex signifi cantly increased by 27 times. Maximum activation is noted in the pulvinar on the right and the lingual gyrus on the left. The activation of the cortex in the study with red illumination of Gabor element after surgery is less than in the study with white illumination, and less than in the study after surgery without illumination of Gabor element. Conclusions. A signifi cant but ambiguous change in the neuronal activity of the cerebral cortex on various stimulation options in patients after mfIOL implantation was established. Further work in this area is planned