Comparing the Effect of Monofocal and Multifocal Intraocular Lenses on Macular Surgery

Abstract

Aim. To compare the effects of previously implanted monofocal and multifocal intraocular lenses (IOL) on macular surgery. Methods. Seventy eyes of 70 patients with epiretinal membrane (ERM) and symptomatic vitromacular traction syndrome that previously had IOL implantation for cataract surgery were included in this prospective randomized clinical trial. Cases were divided into two groups. Group 1 and Group 2 were composed of eyes with monofocal and multifocal IOLs, respectively. The effects of refraction error and IOL decentration at the time of macular surgery performed for ERM and ILM peeling, according to the lens type, were investigated. Pars plana vitrectomy (PPV) was performed to peel ERM and ILM in all cases. Complete ophthalmological examination, fundus fluorescein angiography, and optical coherence tomography imaging were made to all cases, preoperatively and postoperatively. Results. The mean BCVA in Group 1 and Group 2 improved from 0.69 ± 0.15 and 0.38 ± 0.14 logMAR to 0.40 ± 0.14 and 0.10 ± 0.04 logMAR, respectively, at the 6th month. There was no statistically significant difference between the groups in terms of the mean spherical refraction error (P>0.05) and IOL decentration level (P>0.05). The mean time required for macular surgery in Group 2 was statistically significantly longer than that for Group 1 (P<0.05). There was no statistically significant relationship between IOL decentration and macular surgery time in Group 1 (P>0.05), but there it was found in Group 2 (P<0.05). In Group 2, there was a positive correlation between IOL decentration and macular surgery time. Conclusion. In cases with multifocal IOL implants, especially with lens decentration, the time of macular surgery for ERM and ILM peeling during PPV is longer than that of eyes with monofocal IOL due to fluctuations in the clarity of the surgeon’s view.

Improved Intermediate Visual Function with New Monofocal Intraocular Lens in Combined Cataract and Vitrectomy Surgery for Retinal Disease

“…Patel et al [15] reported that combined PPV with multifocal IOL can increase the risk of retinal break. Altun [16] also reported an increased risk of iatrogenic retinal break in eyes with multifocal IOL. However, according to our experience with the Eyhance IOL, there was no distortion of the surgical field via IOL, not only in membrane peeling but also in shaving the peripheral vitreous (Supplementary Video 1).…”

Comparative Evaluation of Visual Outcomes in Combined Cataract and Vitrectomy for Idiopathic Epiretinal Membrane with an Advanced or Conventional Intraocular Lens

“…Another reason for hesitation in the use of multifocal IOL in combined cataract and PPV is that unexpected situations can be encountered during vitrectomy with multifocal IOLs. Multiple concentric optical rings with different dioptres can induce various optical limitations during vitrectomy [29,30]. Yoshino and Inoue reported difficulties in fundus visualization during PPV using a diffractive multifocal IOL.…”

“…Additionally, our study did not include patients with multifocal IOLs. Altun et al [30] reported an increased risk of iatrogenic retinal break in eyes undergoing vitrectomy via multifocal IOLs, and Auffarth et al [26] reported a higher incidence of central macular oedema in the Eyhance IOL group than in the conventional monofocal IOL group. However, in our study, there were no intra- or post-operative complications in either group, including iatrogenic retinal tear, central macular oedema, or ERM recurrence.…”