Trifocal IOL Implantation in Eyes With Previous Laser Corneal Refractive Surgery: The Impact of Corneal Spherical Aberration on Postoperative Visual Outcomes

Abstract

PURPOSE: To analyze corneal aberrations and factors affecting visual outcomes after implantation of a trifocal intraocular lens (IOL) in eyes previously treated with laser corneal refractive surgery. METHODS: This retrospective case series included 222 consecutive eyes implanted with the trifocal FineVision Micro-F IOL (PhysIOL) after laser corneal refractive surgery. The series was divided into two groups according to safety outcomes after lensectomy: eyes with loss of one or more lines of corrected distance visual acuity (CDVA) [n = 59, 26.5%]) (failed eyes group) and eyes with no loss or gain in CDVA lines (n = 163, 73.4%]) (successful eyes group). Distribution of tomographic corneal aberrations (spherical aberration [Z 4 0 ], comatic and root mean square of higher order aberrations [RMS-HOA]), laser corneal refractive surgery error, kappa angle, and CDVA after laser corneal refractive surgery were compared among both groups. RESULTS: Mean CDVA after lensectomy was 0.15 ± 0.07 logMAR (range: 0.05 to 0.30 logMAR) versus 0.03 ± 0.04 logMAR (range: 0.00 to 0.15 logMAR) in the failed and successful eyes groups, respectively ( P < .001). Comparison of both groups showed that failed eyes had a statistically significantly higher grade of hyperopic laser corneal refractive surgery than successful eyes measured as mean sphere (+0.71 ± 3.10 diopters [D] [range: −7.75 to +6.00 D] vs −0.46 ± 3.70 D [range: −10.75 to +6.00 D], P < .01), spherical equivalent (+0.27 ± 3.10 D [range: −8.00 to +5.50 D] vs −0.97 ± 3.60 D [range: −12.50 to +4.90 D], P < .05), and percentage of hyperopic laser corneal refractive surgery (64% vs 43.5%, P < .05). Corneal aberration analysis showed that mean Z 4 0 values were significantly more negative in the failed eyes group than in the successful eyes group (+0.07 ± 0.40 mm [range: −0.82 to +0.65 mm] vs +0.18 ± 0.37 mm [range: −0.79 to +0.87 mm], P < .05). Laser corneal refractive surgery cylinder was distributed homogeneously between both groups, as well as coma and RMS-HOA, kappa angle, and CDVA after laser corneal refractive surgery that were not statistically significant. CONCLUSIONS: Surgeons should consider tomographic corneal spherical aberration after implantation of a trifocal IOL in eyes after keratorefractive surgery, particularly in eyes previously treated with hyperopic laser corneal refractive surgery, to prevent loss of lines of visual acuity after lensectomy. [ J Refract Surg . 2022:38(4):222–228.]

Visual and refractive outcomes after implantation of two models of trifocal intraocular lenses in eyes with previous corneal ablation to treat hyperopia

“…This is not surprising because an IOL with a negative SA increases the negative SA induced by prior hyperopic corneal ablation. Our group recently found poorer visual outcomes in eyes with a higher previous grade of hyperopic LCRS and more negative Z4(0) values when these eyes received a trifocal IOL with a negative SA [17]. However, the outcomes could be influenced not only by the SA of the IOL, but also other issues such as the design of the IOL.…”

Pre- and postoperative angle kappa in MIOL patients after touch-up LASIK

“…Furthermore, the visual acuity of the three different trifocal MIOLs does not seem to be affected by angle κ [ 10 , 21 ]. Cobo-Soriano et al also excluded angle K as a negative factor influencing CDVA in bioptics patients, although they underwent corneal refractive surgery before lens replacement [ 30 ]. In our study, no negative effects were evident in CDVA or SI even in MIOL patients with high angle κ magnitudes after LASIK enhancement.…”

Outcomes and predictive factors in multifocal and extended depth of focus intraocular lens implantation

“…Implantation of multifocal IOLs in the setting of prior LASIK surgery has been generally controversial due to scarce analysis, with limited studies and limited follow-up [14]. However, isolated recent studies have reported good safety and efficacy for trifocal IOLs in laser-corrected eyes [15 ▪ ,16]. One such study, a retroactive analysis of 222 eyes [15 ▪ ] examined outcomes of trifocal implantation in eyes with prior laser corneal refractive surgery.…”

“…However, isolated recent studies have reported good safety and efficacy for trifocal IOLs in laser-corrected eyes [15 ▪ ,16]. One such study, a retroactive analysis of 222 eyes [15 ▪ ] examined outcomes of trifocal implantation in eyes with prior laser corneal refractive surgery. About 5% of the eyes had a significant loss of corrected distance vision.…”