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Meta-Analysis
. 2018 Sep 27;33(44):e275.
doi: 10.3346/jkms.2018.33.e275. eCollection 2018 Oct 29.

Trifocal versus Bifocal Diffractive Intraocular Lens Implantation after Cataract Surgery or Refractive Lens Exchange: a Meta-analysis

Chang Ho Yoon  1   2 , In-Soo Shin  3 , Mee Kum Kim  1   2
Affiliations
Meta-Analysis

Trifocal versus Bifocal Diffractive Intraocular Lens Implantation after Cataract Surgery or Refractive Lens Exchange: a Meta-analysis

Chang Ho Yoon et al. J Korean Med Sci. .

Abstract

Background: We compared the efficacy between trifocal and bifocal diffractive intraocular lens (IOL) implantation.

Methods: Through PubMed, MEDLINE, EMBASE, and CENTRAL, we searched potentially relevant articles published from 1990 to 2018. Defocus curves, visual acuities (VAs) were measured as primary outcomes. Spectacle dependence, postoperative refraction, contrast sensitivity (CS), glare, and higher-order aberrations (HOAs) were measured as secondary outcomes. Effects were pooled using random-effects method.

Results: We included 11 clinical trials, with a total of 787 eyes (395 subjects). The trifocal IOL group showed better binocular distance VA corrected with defocus levels of -0.5, -1.0, -1.5, and -2.5 diopter than the bifocal IOL group (All P ≤ 0.004). The trifocal IOL group showed better monocular uncorrected distance and intermediate VAs (mean difference [MD], -0.04 logarithm of the minimum angle of resolution [logMAR]; 95% confidence interval [CI], -0.07, -0.01; P = 0.006 and MD, -0.07 logMAR; 95% CI, -0.13, -0.01; P = 0.03, respectively). Postoperative refraction, glare, CS, and HOAs were not significantly different from each other.

Conclusion: The overall findings indicate that trifocal diffractive IOL implantation is better than the bifocal diffractive IOL in intermediate VA, and provides similar or better in distance and near VAs without any major deterioration in the visual quality.

Keywords: Bifocal; Diffractive; Intraocular Lens; Meta-analysis; Trifocal.

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Conflict of interest statement

Disclosure: The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Flow chart showing searching strategy used in selection of publications for inclusion in this meta-analysis.
CENTRAL = Cochrane Central Register of Controlled Trials.
Fig. 2
Fig. 2. Forest plot of trifocal versus bifocal diffractive IOL: binocular corrected defocus curves.
IOL = intraocular lens, MD = mean difference, SD = standard deviation, IV = inverse variance, CI = confidence interval, D = diopter.
Fig. 3
Fig. 3. Forest plot of trifocal versus bifocal diffractive IOL: (A) monocular VAs and (B) the number of patients who did not achieve binocular UIVA of 0.1 logMAR.
IOL = intraocular lens, VA = visual acuity, UDVA = uncorrected distance visual acuity, UIVA = uncorrected intermediate visual acuity, UNVA = uncorrected near visual acuity, logMAR = logarithm of the minimum angle of resolution, SD = standard deviation, MD = mean difference, IV = inverse variance, CI = confidence interval, M-H = Mantele-Haenszel, RR = risk ratio.
Fig. 4
Fig. 4. Forest plot of trifocal versus bifocal diffractive IOL: binocular CS under photopic (A) and mesopic (B) conditions; and glare (C).
IOL = intraocular lens, MD = mean difference, CS = contrast sensitivity, SD = standard deviation, IV = inverse variance, CI = confidence interval, SE = standard error, OR = odds ratio.
See this image and copyright information in PMC

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