Refractive Lens Exchange in Hyperopic Presbyopes with the Acrysof IQ Panoptix Intraocular Lens: One-Year Results and Analysis of the Literature

Refractive lens exchange: What are the red lines?

Practical advancements in phacoemulsification techniques and intraocular lenses and the wide availability of phacoemulsification machines have led refractive lens exchange (RLE) to increase in popularity. Ethical boundaries in RLE have subsequently been pushed to include patients at higher risk of complications. In this editorial, we consider RLE outcomes and complications per type of refractive error, together with preoperative, intraoperative and postoperative ethical obligations for refractive surgeons. In the conclusions section, we propose an algorithm for ethics-guided indications to RLE.

Retinal detachment after refractive lens exchange: A narrative review

Refractive lens exchange (RLE) allows to correct ametropias and presbyopia by replacing the crystalline lens with an extended depth of focus or multifocal intraocular lens (IOL). Retinal detachment (RD) is one of the most serious adverse events after RLE. This study aimed to review the evidence related to the risk of RD after RLE and clinical outcomes. A search using PubMed and a snowball search approach was conducted to identify articles and case reports. According to the literature, the risks of RD should be considered in patients <60 years old with axial lengths >23 mm. Only nine articles reported visual acuity (VA) after RD in RLE, and only 25% of eyes had a VA > 20/40. Considering that the decrease in VA might be uniform for all types of IOLs after RD, surgeons should focus on selecting the patient to prevent RD rather than on a particular IOL optical design based on the potential risk of DR.

Outcomes after bilateral implantation of AcrySof IQ PanOptix trifocal intraocular lens: a prospective interventional study

Background

Implantation of multifocal intraocular lenses (IOLs) is becoming increasingly popular for the treatment of visual demands at various distances in patients undergoing phacoemulsification cataract surgery. We aimed to assess the visual performance and rates of photic phenomena, posterior capsule opacification (PCO), and spectacle independence in patients with bilateral implantation of the AcrySof® IQ PanOptix® multifocal IOL model TFNT00 at one and six months postoperatively.

Methods

This prospective interventional cohort study included adult patients who underwent uneventful phacoemulsification cataract surgery with bilateral implantation of AcrySof® IQ PanOptix® IOL. Uncorrected and corrected visual acuities at far, intermediate, and near distances were measured preoperatively and at the one- and six-month postoperative follow-up examinations. The rates of photic phenomena, postoperative need for near and distance spectacles, and PCO were also recorded.

Results

We included 164 eyes of 82 patients with a male-to-female ratio of 38 (46.3%) to 44 (53.7%) and a mean (standard deviation [SD]) age of 52.37 (7.62) years. There were statistically significant improvements in the visual acuities of both eyes across all distances at the one- and six-month follow-up examinations compared to the preoperative values (all P < 0.001), except for corrected near visual acuity in the right eye (P > 0.05) at six-month. We also detected significant postoperative improvements in visual acuities of both eyes across all distances at the six-month follow-up compared to values at the one-month follow-up (all P < 0.05), except for corrected near visual acuity in the right eye (P > 0.05). The photic phenomenon was reported by 12 (14.6%) of the 82 patients at the six-month postoperative follow-up. Five (6.1%) and eight (9.8%) of the 82 patients reported using spectacles for distance and near, respectively. Additionally, PCO developed in 19 (11.6%) of the 164 included eyes, although it was not clinically significant at six months.

Conclusions

The AcrySof® IQ PanOptix® IOL model TFNT00 is recommended for use, given its excellent performance in all ranges of vision, a high rate of spectacle independence, and a good safety profile. Future comparative studies with longer follow-up periods are warranted to verify superiority of its performance over that of other available multifocal IOLs.

Visual Outcomes and Patient Satisfaction After Bilateral Refractive Lens Exchange with a Trifocal Intraocular Lens in Patients with Presbyopia

INTRODUCTION

Refractive lens exchange (RLE) patients represent a unique population with a different baseline and set of expectations compared to their cataract counterparts. Visual outcomes and patient satisfaction following RLE with bilateral implantation of a trifocal intraocular lens (IOL) were assessed in a cohort of patients with presbyopia and without cataract.

METHODS

Charts of patients with presbyopia who underwent femtosecond laser-assisted RLE with bilateral implantation of the PanOptix trifocal IOL (toric and non-toric) at a single-surgeon, private practice center from September 2019 to August 2020 were retrospectively reviewed. Eyes with prior keratorefractive surgery, amblyopia, or underlying pathology were excluded. Primary endpoints included corrected and uncorrected visual acuity at distance (CDVA and UDVA), intermediate (DCIVA and UIVA), and near (DCNVA and UNVA) at 6 months. Secondary endpoints included residual refractive error, patient-reported satisfaction, spectacle independence, and visual disturbance profile as assessed by a validated questionnaire at 6 months.

RESULTS

Seventy-eight eyes of 39 patients (mean age 56 ± 6 years; 79% female) were included. Most eyes were hyperopic (mean SE 2.35 ± 1.81). Postoperatively, 100% and 92% of eyes were within ± 1.00 D and ± 0.50 D of emmetropia, respectively. One hundred percent, 97%, and 97% of patients achieved UDVA, UNVA, and UIVA of logMAR 0.1 or better. Starbursts were the most frequent (67%) and bothersome (41%) visual disturbance cited, but nearly half (41%) of patients rated them as absent or "not bothersome at all." Overall, 77% of patients reported achieving complete spectacle independence with 87% and 90% of patients stating they were satisfied with their vision and would recommend the same procedure to others, respectively.

CONCLUSIONS

RLE with bilateral implantation of the PanOptix IOL is a safe and effective procedure with good patient satisfaction. Because of their relatively clear native lenses and visually demanding needs compared to their cataract counterparts, surgeons should take extra precautions to counsel RLE patients on the limitations of trifocal technology.

Hyperopic LASIK Enhanced by Pharmacological Treatment of Presbyopia

Purpose: Regression of the refractive outcome is a major concern of LASIK procedures mainly in presbyopic patients. The purpose of this study was to evaluate the long-term efficacy of the pharmacological treatment of presbyopia performed with Benozzi's method, in combination with hyperopic LASIK surgery in presbyopic population. Methods: A nonrandomized case series was developed, including presbyopic patients who underwent bilateral "Hyperopic LASIK surgery" and were pharmacologically treated with Benozzi's Method from January 2011 to August 2018, with at least 2 years of follow-up, at two private ophthalmological clinics of Argentina. Main outcomes were spherical equivalent (SE), uncorrected distance visual acuity (UDVA), and uncorrected near visual acuity (UNVA). Measurements were evaluated at baseline and postoperative at 1 month (without Benozzi's treatment), 2 months (starting with Benozzi's treatment), and 2 years. The SE stability across the time was statistically compared. Results: A total of 84 eyes of 42 patients, with a mean age at the time of the surgery of 51.07 ± 4.5 (42-59), were found following 2 years of follow-up. Patients have improved and maintained UDVA, achieving Jaeger 1 in the second postoperative month, which was maintained up to the last year of follow-up. Refractive stability across the time is observed comparing first month after surgery with the last year of follow-up, without statistical significant difference (p: 0.11). Conclusion: Hyperopic presbyopic patients that underwent LASIK surgery and 1 month after surgery started with the pharmacological treatment of presbyopia (Benozzi's method) results in excellent UNVA and UDVA that is stable over time without refractive regression.

Comparative Visual Outcome Analysis of a Diffractive Multifocal Intraocular Lens and a New Diffractive Multifocal Lens with Extended Depth of Focus

This study compares the visual and refractive performance of the TECNIS Synergy (DFR00V-DFW150-225-300-375) multifocal intraocular lens (IOL) and the AcrySof IQ PanOptix (TFAT00-30-40-50-60) multifocal IOL. Patients who underwent phacoemulsification and cataract extraction and received either a multifocal Synergy or PanOptix IOL were included. Monocular uncorrected distance (UDVA), intermediate (UIVA), near (UNVA), and corrected distance (CDVA) visual acuities were assessed at three and six months postoperatively. Secondary outcome measures of photic phenomena were also assessed. A total of 140 patients (224 eyes) were included in this study, with 69 patients (105 eyes) in the Synergy group and 71 patients (119 eyes) in the PanOptix group. There were no statistically significant differences in UIVA or CDVA measurements across all time points. When assessing UDVA, at three months postoperatively, there were more eyes in the PanOptix group with vision better than 20/40 (p = 0.04). At three and six months postoperatively, the average UNVA was superior in the Synergy group (p = 0.01, 0.002). While the Synergy group reported more night vision disturbances at one and three months (p = 0.01, 0.03), the PanOptix group had more night vision disturbances at six months (p = 0.02). Although not statistically significant, the AcrySof IQ PanOptix multifocal IOL demonstrated better UDVA and UIVA sooner postoperatively than the TECNIS Synergy multifocal IOL. The Synergy IOL provided statistically better UNVA compared to the PanOptix IOL at three and six months postoperatively. Synergy patients reported more early photic phenomena than PanOptix patients, which later diminished.

Visual performance, safety and patient satisfaction after bilateral implantation of a trifocal intraocular lens in presbyopic patients without cataract

Background

The aim was to evaluate the safety and efficacy of a trifocal intraocular lens (IOL) for the correction of presbyopia and to assess patient satisfaction.

Methods

Records from three centres were reviewed to select presbyopic patients having undergone bilateral refractive lens exchange and implantation of the AT LISA tri 839MP multifocal IOL. Postoperatively, monocular and binocular distance, intermediate and near visual acuities, corrected and uncorrected, and subjective refraction were measured. Patients also completed a quality of life questionnaire. Safety evaluation included IOL stability and postoperative complications.

Results

72 eyes (36 patients) were analysed. No clinically significant difference between pre- and postoperative corrected distance visual acuity (CDVA) was found for monocular or binocular measurements. Mean postoperative monocular CDVA was 0.02 ± 0.04 logMAR. Mean refractive values all improved statistically significantly compared with preoperative baseline (p ≤ 0.0064). Overall, 82.4% of eyes had spherical equivalent within ± 0.5 D and 97.1% within ± 1.0 D of emmetropia with a mean accuracy of -0.10 ± 0.41 D. Spectacle independence for distance, intermediate and near visual acuity was 87.5%, 84.4% and 78.1% respectively, and 78.1% of patients were satisfied with their postoperative, spectacle-free vision. Eight eyes received Nd:YAG laser treatment. No other IOL-related safety issues were reported.

Conclusion

AT LISA tri 839MP multifocal IOL bilaterally implanted in presbyopic patients provided excellent distance, intermediate and near visual outcomes with very accurate correction of refraction. These results were associated with a high level of spectacle independence and patient satisfaction.

Trial registration

Trial registered on https://clinicaltrials.gov/ under the identification NCT03790592 (31/12/2018).