To assess efficacy, safety and predictability after refractive lens exchange (RLE) in patients who had bilateral implantation of a distance-dominant diffractive bifocal intraocular lens (IOL). Seventeen patients (34 eyes) were examined after RLE with bilateral implantation of a diffractive bifocal 447D IOL. Eyes were divided into myopic and hyperopic groups. Monocular uncorrected distance visual acuity, best-corrected distance visual acuity (BCVA), uncorrected distance near visual acuity, and best distance-corrected near visual acuity (BCNVA) were recorded preoperatively and 6 months after surgery. Efficacy indexes were 1.10 for myopic and 0.98 for hyperopic eyes, at 6 months postoperatively. No eye lost > or = 1 line of BCVA. For the myopic group, four eyes gained 1 line, and six eyes gained > or = 2 lines; for the hyperopic group, three eyes gained 1 line, and five eyes gained > or = 2 lines. Safety indexes were 1.21 and 1.08 for myopic and hyperopic eyes respectively. No eye lost > or = 1 line of BCNVA. Safety indexes at near were 1.02 for myopic and 1.01 for hyperopic eyes. Efficacy indexes at near were 1.02 for myopic and 1.00 for hyperopic eyes. Six-month results of bilateral implantation of a distance-dominant diffractive bifocal IOL for RLE demonstrated efficacy, safety, and predictability in correcting ametropia and presbyopia.