Clinical outcomes of plate-haptic diffractive multifocal toric IOL in cataract eyes with long axial length and corneal astigmatism

Abstract

The prospective study is aimed to determine the clinical outcomes of plate-haptic diffractive multifocal toric intraocular lens (IOL) implantation in cataract patients with long axial length and corneal astigmatism. Visual outcomes, defocus curves, contrast sensitivity, rotational stability, vector changes of refractive astigmatism and patient satisfaction were assessed over 3 months. Vector analysis was performed by the Alpins method. A total of 36 eyes (18 patients) underwent cataract surgery with implantation of AT LISA toric 909 M multifocal toric IOL. Preoperatively, mean axial length AL was 27.31 ± 2.20 mm. Mean manifest sphere and cylinder were - 6.66 ± 5.37 diopter (D) and - 1.88 ± 1.11 D. Postoperatively, mean manifest sphere and cylinder were reduced to 0.13 ± 0.23 D and - 0.29 ± 0.32 D, respectively (P < 0.05, Wilcoxon test). Mean uncorrected distance and near visual acuities (logMAR) were 0.40 ± 0.10 and 0.19 ± 0.16, respectively. At 3 months, 91.7% of patients showed IOL rotation of less than 5 degrees. The difference vector was 0.34 ± 0.26 D, for a correction index of 0.93 ± 0.40 at 3 months. In summary, plate-haptic diffractive multifocal toric IOL improves distance and near visual functions and reduces refractive astigmatism in cataract patients with long axial length and corneal astigmatism.Trial registration: NCT04833491.

Keywords: Cataract surgery; Corneal astigmatism; Long axial length; Multifocal toric IOL.

Fig. 1

Defocus curves at 3 months after surgery. Monocular, defocus curve obtained under monocular condition; Binocular, defocus curve obtained under binocular condition. The binocular defocus curve showed better visual acuity compared with the monocular defocus curve at each test step (P < 0.05, paired t test.).

Fig. 2

Clinical evaluation of contrast sensitivity function (CSF) after surgery. (A) CSF tested at 2.5 m without glare; (B) CSF tested at 2.5 m with glare; (C) CSF tested at 1.25 m without glare; (D) CSF tested at 1.25 m with glare. 1 W, 1 week after surgery; 1 M, 1 month after surgery; 3 M, 3 months after surgery. *P < 0.05, Wilcoxon test, LogCS of different distance compared between glare and no-glare conditions at the same spatial frequency.

Fig. 3

IOL rotation after surgery. 1 W, 1 week after surgery; 1 M, 1 month after surgery; 3 M, 3 months after surgery.

Fig. 4

Vector analysis using the Alpins vectorial method at 3 months after surgery. (A) Target induced astigmatism at 3 months; (B) Surgically induced astigmatism at 3 months; (C) Difference vector at 3 months.

Fig. 5

Questionnaire and photic phenomenon results. (A) Questionnaire of satisfaction of visual acuity; (B) Questionnaire of spectacles usage; (C) Questionnaire of photic phenomenon; (D) Questionnaire of attitudes toward the IOL.