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. 2018 Mar 18;11(3):484-492.
doi: 10.18240/ijo.2018.03.20. eCollection 2018.

Comparison of visual outcomes with implantation of trifocal versus bifocal intraocular lens after phacoemulsification: a Meta-analysis

Juan-Juan Yang  1 , Qiu-Ping Liu  2 , Jing-Ming Li  1 , Li Qin  1
Affiliations

Comparison of visual outcomes with implantation of trifocal versus bifocal intraocular lens after phacoemulsification: a Meta-analysis

Juan-Juan Yang et al. Int J Ophthalmol. .

Abstract

Aim: To compare a trifocal intraocular lens (IOL) and a bifocal IOL implantation in improving visual function after cataract surgery.

Methods: Eligible literatures were systematically searched through EMBASE and PubMed databases. The inclusion criteria were prospective comparative clinical trials on cataract surgery comparing trifocal IOL with bifocal IOL implantation that assessed visual acuity, contrast sensitivity and subjective vision quality. The effects were computed as standardized mean differences and pooled using fixed-effect or random-effect models.

Results: Four prospective randomized controlled trials (RCTs) and five cohorts provided data were included by a systematic review, comprising 265 eyes implanted with trifocal IOLs and 264 eyes implanted with bifocal IOLs. Monocular distance visual acuity (VA) showed a statistically significant but small difference that favored trifocal IOLs (MD=-0.06; 95%CI, -0.10 to -0.02; Z=2.90, P=0.004 for uncorrected distance VA, and MD= -0.02; 95%CI, -0.03 to -0.00; Z=2.02, P=0.04 for corrected distance VA), but the data did not suggest that the effect of trifocal IOL implantation would clinically outperform bifocal IOL implantation. There was no significant difference in monocular near VA (MD=-0.01; 95%CI, -0.07 to 0.04; Z=0.42, P=0.68 for distance-corrected near VA, and MD=-0.01; 95%CI, -0.06 to 0.03; Z=0.55, P=0.58 for corrected near VA) or refraction between two groups. Contrast sensitivity and subjective visual quality had no conclusive results.

Conclusion: All results indicate that trifocal IOL and bifocal IOL had similar levels of monocular distance and near VA.

Keywords: Meta-analysis; bifocal intraocular lens; trifocal intraocular lens; visual function.

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Figures

Figure 1
Figure 1. Flow diagram of study selection process
RCTs: Randomized controlled trials.
Figure 2
Figure 2. Subgroup analysis of postoperative monocular UDVA, CDVA, UNVA, DCNVA
This forest plot showed the mean difference in visual acuity (logMAR) along with associated 95% CI, comparing the implantation of trifocal with bifocal IOLs. A: Forest plot showing the MD of UDVA; B: Forest plot showing the MD of CDVA; C: Forest plot showing the MD of UNVA; D: Forest plot showing the MD of DCNVA; In bold: subgroup and total finding of effect size calculation with the random effect model; the diamond shows the mean effect size and its standard deviation. CI: Confidence interval; df: Degrees of freedom; IOL: Intraocular lens; IV: Inverse variance; SD: Standard deviation.
Figure 3
Figure 3. Random effects pooled estimates of postoperative monocular UIVA and DCIVA
This forest plot showed the mean difference in visual acuity (logMAR) along with associated 95% CI, comparing the implantation of trifocal with bifocal IOLs. A: Forest plot showing the MD of UIVA; B: Forest plot showing the MD of DCIVA.
Figure 4
Figure 4. Random effects pooled estimates of postoperative binocular UDVA, UIVA and UNVA
This forest plot showed the mean difference in visual acuity (logMAR) along with associated 95%CI, comparing the implantation of trifocal with bifocal IOLs. A: Forest plot showing the MD of UDVA; B: Forest plot showing the MD of UIVA; C: Forest plot showing the MD of UNVA.
Figure 5
Figure 5. Random effects pooled estimates of postoperative cylinder (D), sphere (D) and spherical equivalent (SE; D)
This forest plot showed the mean difference in visual acuity (logMAR) along with associated 95% CI, comparing the implantation of trifocal with bifocal IOLs. A: Forest plot showing the MD of cylinder; B: Forest plot showing the MD of sphere; C: Forest plot showing the MD of SE.
Figure 6
Figure 6. Funnel plot for the results between trifocal and bifocal IOLs.
See this image and copyright information in PMC

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