Trifocal Versus Monofocal Lens Implantation After Previous Corneal Laser Surgery For Myopia

To evaluate, in a large cohort of patients, visual and refractive outcomes of trifocal intraocular lens (IOL) implantation after phacoemulsification in eyes with previous laser vision correction (LVC) for myopia, and to compare these clinical outcomes,  with those obtained with monofocal aspheric IOLs, often used in a monovision strategy. 

Clínica Baviera, Madrid, Spain

This multicenter, multisurgeon single-protocol, retrospective, comparative case series study comprised consecutive eyes with a history of a previous myopic LVC performed at our institution that underwentlensectomy (both for cataract and refractive lens exchange) with a trifocal or aspheric monofocal IOL implantation. The lens procedures were performed at the Baviera Clinics in Spain from 2015 to 2019. The study comprised 211 eyes of 170 patients in the monofocal group and 211 eyes of 161 patients in the trifocal group. Mean preoperative and postoperative LVC refractive and visual results were comparable in both groups.

Post lensectomy, in the monofocal group there was an intended myopic residual spherical equivalent that resulted in a worse uncorrected distance visual acuity and better efficacy and predictability outcomes in the trifocal group. However, distance corrected visual acuity was equivalent in both groups and safety index was minimally, albeit significantly higher in the monofocal group (0.96 versus 0.98). Uncorrected near visual acuity monocular and binocularly was significantly better in the trifocal group. Laser enhancement rate post-lensectomy was significantly higher in the trifocal group (15.2% versus 8.5%). 

Trifocal lens implantation after lens phacoemulsification in eyes with previous myopic LVC is a safe, effective and predictable procedure. Monofocal lens implantation with a monovision strategy provided minimally better safety results but significantly worse near vision and spectacle independence.