New Monofocal Plus Iol May Perform Better Than Trifocality In Oculus Melior Situation- A Multifocal-Iol Explantation Case Report

A patient presented himself with bilateral trifocal IOLs. Upon examination one eye turned out to be amblyopic. Visual acuity in leading eye was not compensating for the severe perception of photic phenomena and loss in constrastivity. 

International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University Hospital Heidelberg, Germany

MIOL in non-amblyopic eye was explanted and a more suitable IOL profile was selected- a non-diffractive extended monofocal lens (Evolux 1110ACH SIFI, Lavinaio, Italy). Subjective refraction, halo and glare simulation, corrected and uncorrected visual acuity (VA), monocular [logMar] for distance, intermediate and near vision, as well as a best-corrected defocus curve analysis were evaluated 1 week, 1 month and 3 months after surgery.

Monocular visual acuity in logMAR at 1/3 months were UDVA -0.10/-0.14; UIVA 0.20/0.02; UNVA 0.44/0.42; CDVA -0.10/ -0.14; DCIVA 0.06/0.02; DCNVA 0.40/ 0.42. The monocular distance-corrected defocus curve at 1 months showed a continuous visual acuity of 0.22 or better in the range of +0.50 to -1.50 diopters of defocus. After 3 months a continuous visual acuity of 0.22 or better was shown again in the range of +0,5 to -1.5 diopters of defocus. The patients mainly reported drastic reduction in photic phenomena regarding the halo and glare simulation. Evaluation of visual acuity outcomes 6-months postoperatively is ongoing.

For amblyopic eyes trifocal IOLs might not be the most suitable option. Seeking for best visual acuity outcome is not the only key postsurgical target because side effects like photic phenomena, loss in contrast sensitivity or higher light requirements cannot be neglected.