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First Author: J.Steinberg GERMANY
Co Author(s): S. Linke A. Frings T. Katz
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Diffractive-refractive or bifocal multifocal intraocular lenses (MIOLs) enable unaided vision in infinity and in predefined near distance. Dysfunction of the MIOLs may be solved by glasses or by replacing the implanted lenses. Add on monofocal, toric or multifocal lenses are used to correct monofocal pseudophakes. Implanting an Add on MIOL over a MIOL has not been reported in literature.
University Medical Center Hamburg-Eppendorf, Germany, and Care Vision Refractive Centers, Germany and Austria
We present a case of a 49-year-old mild hyperopic man who had been implanted bilaterally with bifocal MIOLs thereby achieving a good uncorrected distance visual acuity (UDVA). However, low uncorrected near (UNVA) and intermediate vision (UIVA) was achieved. To improve his UNVA and UIVA, Add On diffractive refractive MIOLs were bilaterally implanted.
Prior to MIOL implantation the patient had good UDVA (decimal acuity: right eye (OD): 1.0; left eye (OS): 0.9; both eyes (OU): 1.0) but low UIVA (OD: 0.4; OS: 0.2; OU: 0.4) and UNVA (OD: 0,1; OS: 0,1; OU: 0,1). Manifest subjective refraction was +1.75 Diopter (D) sphere without subjective astigmatism in both eyes. After bifocal IOL implantation in both eyes, no relevant increase of UIVA and UNVA could be noted. Six months after the 1st procedure, a sulcus fixated multifocal Add on lens with distance plano power and addition of 3.00 D (add on MS714PBdiff, 1st Q, Mannheim, Germany) was implanted first in the left eye and afterwards in the right eye. While UDVA remained high (OD: 1.0; OS: 1.0; OU: 1.0), UIVA (OD: 0.4; OS: 0.4; OU: 0.6) and UNVA (OD: 1.0; OS: 1.0; OU: 1.0) increased notably. Postoperative manifest refraction was OD: +1.00 D/ -1.00 D x 171Ḟ, OS: plano. Contrast sensitivity tests demonstrated normal contrast sensitivity in binocular vision. In both eyes the Add on lenses remain co-centered without opacity between or behind the implants and no contact between both implants in both eyes.
The case reported contributes to the notion of the safety, efficiency and reversibility of Add on diffractive MIOLs combined with bifocal MIOLs.