Multifocal Intraocular Lens Exchange To Monofocal For The Managementof Neuroadaptation Failure
Published 2023 - 41st Congress of the ESCRS
Reference: PP15.01 | DOI: 10.82333/skan-6j03
Authors: Mario Canto Cerdan* 1 , Olena Al-shymali 1 , Jorge Alio Del Barrio 2 , Colm McAlinden 3 , Laura Primavera 1 , Jorge Alió 2
1Cornea, Cataract and Refractive Surgery Unit,Vissum,Alicante,Spain, 2Cornea, Cataract and Refractive Surgery Unit,Vissum,Alicante,Spain;Division of Ophthalmology, School of Medicine,Universidad Miguel Hernandez,Alicante,Spain, 3Department of Ophthalmology,Royal Gwent Hospital,Newport,United Kingdom
The aim of this study was to evaluate visual, refractive, quality of vision, visual function and satisfaction of multifocal intraocular lens (MF-IOL) exchange with a monofocal IOL (MNF-IOL) in dissatisfied patients following MF-IOL implantation.
Vissum (Miranza Group), Alicante, Spain
This was a retrospective case series. Bilateral IOL exchange (MF-IOL to MNF-IOL) was performed in 13 patients (26 eyes) with neuroadaptation failure. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA) and corrected near visual acuity (CNVA), and refraction outcomes (sphere, cylinder and spherical equivalente) were measured. Questionnaires including the Quality of Vision (QoV), Visual Function Index (VF-14 and Rasch-revised VF-8R version), and a satisfaction questionnaire were used.
The mean time for IOL exchange was 15 months. CDVA improved from 20/26 to 20/23 (p=0.028). UNVA worsened after exchange from 20/47 to 20/62 (p=0.024). QoV scores improved significantly across all three subscales after exchange. Visual function for far distance improved with a change in VF-14 score from 74.2± 4.8 to 90.9±9.1 (p=0.03). The VF-8R score showed worsening although not statistically significant. Near vision spectacle independence was totally or partially lost in all cases. Ten patients (77%) reported they would not repeat the lens exchange. Safety and efficacy indices changed from 1.23 to 0.85, respectively, at three months to 1.24 (p=0.871) and 0.89 (p=0.568), respectively, at one year.
IOL exchange (multifocal to monofocal) to solve neuroadaptation failure in this case series resulted in significant improvements in dysphotopsia and improved distance visual function. However, UNVA worsened and patient satisfaction after exchange remained suboptimal with 77% claiming they would not repeat the lens exchange, suggesting the value of near vision spectacle independence for these patients.