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. 2025 Aug 20.
doi: 10.1007/s40123-025-01202-2. Online ahead of print.

Secondary Trifocal Intraocular Lens Implantation in Dense Cataracts: A Promising Alternative to One-Step Surgery

Jingyu Qu  1   2 , Wei Xiao  3 , Yue Wang  3 , Ya Jiao  3 , Shiqi Dong  3 , Rong Xu  4   5
Affiliations

Secondary Trifocal Intraocular Lens Implantation in Dense Cataracts: A Promising Alternative to One-Step Surgery

Jingyu Qu et al. Ophthalmol Ther. .

Abstract

Introduction: To compare the benefits of secondary trifocal intraocular lens (IOL) implantations versus one-step IOL implantations in managing dense cataracts.

Methods: Patients with dense cataracts, a preoperative axis length (AL) of 21.00-27.00 mm, and corneal astigmatism ≤ 1.00 D were enrolled at Wuhan Aier Hankou Eye Hospital. Patients unsuitable for femtosecond laser-assisted cataract surgeries (FLACS) were excluded. Patients who underwent one-step monofocal IOL implantations were involved in group A, and those who accepted two-step trifocal IOL implantations entered group B. Pre- and postoperative AL, corneal keratometry (K) value, visual acuity, and endothelial cell density (ECD) were measured. Postoperative spherical equivalent (SE), numerical error (NE), and mean absolute error (MAE) were calculated.

Results: Applying the inclusion/exclusion criteria, 42 eyes were finally included in group A, and 32 eyes were involved in group B. In group B, six eyes (15.79%) were identified as unsuitable for multifocal IOL (MIOL) implantation because of fundus diseases. Patients in group B achieved a greater proportion of SE and NE closer to 0 D. The postoperative MAE of group B was also obviously lower than that of group A. Uncorrected distant visual acuity (UDVA) of patients in group B was superior to that in group A during the 90-day postoperative follow-up period. Postoperative AL, surgically induced astigmatism (SIA), and ECD loss did not show significant differences between the two groups.

Conclusions: Compared to one-step IOL implantation, the two-step approach allowed more accurate IOL power calculation, reduced refractive error, and better UDVA; did not increase SIA or ECD loss; and allowed for fundus disease screening, making it a good choice in dense cataracts for MIOL implantations.

Trial registration: This trial was registered with the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ).

Trial registration number: ChiCTR2100043570.

Keywords: Accuracy; Dense cataract; Refractive error; Safety; Trifocal intraocular lens implantation.

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Conflict of interest statement

Declarations. Conflict of Interest: Rong Xu was initially affiliated with Wuhan Aier Hankou Eye Hospital during the early stage of the study. She is currently affiliated with Wuhan Fourth Hospital. The study received no funding or financial support from Wuhan Aier Hankou Eye Hospital. There are no conflicts of interest related to these affiliations. Jingyu Qu, Wei Xiao, Yue Wang, Ya Jiao, Shiqi Dong, and Rong Xu declare that they have no conflict of interest. Ethics Approval: This prospective nonrandomized controlled trial was conducted at Wuhan Aier Hankou Eye Hospital, Hubei Province, People’s Republic of China, from March 2021 to March 2024. The trial was registered at Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ) with registration number ChiCTR2100043570 (registration on 21/02/2021). This study was approved by the Institutional Review Board of Wuhan Aier Hankou Eye Hospital (approval number: HKAIER2020IRB-007-01) and adhered to the Declaration of Helsinki. Written informed consent was obtained from all participants. This trial followed CONSORT 2010 guidelines.

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References

    1. Liu Y, Lan Q, Sun T, et al. Binocular visual function after unilateral versus bilateral implantation of segmented refractive multifocal intraocular lenses: a pilot study. Graefes Arch Clin Exp Ophthalmol. 2022;260(4):1205–13. https://doi.org/10.1007/s00417-021-05496-3 . - DOI - PubMed
    1. Collaborators. GBaVI, Study. VLEGotGBoD. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the right to sight: an analysis for the global burden of disease study. Lancet Glob Health. 2021;9(2):e144–e160. https://doi.org/10.1016/s2214-109x(20)30489-7 .
    1. Hashemi H, Pakzad R, Yekta A, et al. Global and regional prevalence of age-related cataract: a comprehensive systematic review and meta-analysis. Eye (Lond). 2020;34(8):1357–70. https://doi.org/10.1038/s41433-020-0806-3 . - DOI - PubMed
    1. Fang R, Yu YF, Li EJ, et al. Global, regional, national burden and gender disparity of cataract: findings from the global burden of disease study 2019. BMC Public Health. 2022;22(1):2068. https://doi.org/10.1186/s12889-022-14491-0 . - DOI - PubMed - PMC
    1. Chen Z, Wu Y, Sun Y, et al. Adjusted femtosecond laser capsulotomy distance in white cataracts to decrease incomplete capsulotomy: a randomized comparative cohort study. Graefes Arch Clin Exp Ophthalmol. 2022;260(8):2591–5. https://doi.org/10.1007/s00417-022-05630-9 . - DOI - PubMed

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