Evaluation Of Visual Outcomes And Patient Satisfaction Following Implantation Of Enhanced Monofocal Iol In Post-Corneal Refractive Surgery Patients.

In patients with prior corneal refractive surgery, IOL power calculation and the selection of type of IOL is still a challenge. After corneal refractive surgery, the keratometry of the cornea and relationship of the anterior and posterior corneal curvatures is altered. It may also induce higher order aberrations. Use of multifocal IOLs in eyes with pre-existing aberrations may worsen the optical quality of image. Enhanced monofocal IOL is designed to provide Distance corrected visual acuity (DCVA) comparable with an aspheric monofocal IOL, with additional benefit of improved intermediate visual acuity. With the aim to study the visual outcomes of enhanced monofocal IOL in eyes with prior refractive surgery, the study was designed.

An ambispective case control study was conducted at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS New Delhi, India from February 2023 to November 2023.It included patients who had cataract along with history of prior corneal refractive surgery. Patients with age > 21 years, corrected distance visual acuity £ 6/9 and willing to participate in the study were included, while those with any ocular co-morbidity or unwilling to participate were excluded.

All patients who were included in the study underwent cataract surgery. Pre-operative uncorrected and best corrected VA for near and distance vision was assessed. Optical biometry using the IOL Master 700 in Laser Vision Correction mode was done. IOL power was chosen using Barrett’s True-K formula. The patients were divided in two groups based on intra-ocular lens (IOL) chosen. Group 1 were implanted with an enhanced monofocal IOL (Tecnis Eyhance ICB00), while Group 2 implanted with a standard monofocal IOL. Postoperatively, following parameters were evaluated- uncorrected and best corrected visual acuity for distance, intermediate, and near, refraction, contrast sensitivity, and quality of life using the NEI RQL-42 questionnaire.

A total of 32 eyes of 21 patients were recruited in 2 groups: 16 cases (Enhanced Monofocal IOL) and 16 controls (Standard Monofocal IOL). The Enhanced Monofocal IOL performed better than the control group in terms of all visual acuity parameters. However, it performed significantly better in terms of Distance-corrected intermediate vision (p=0.05) and contrast sensitivity (p=0.03). Subjective analysis using NEI RQL-42 questionnaire revealed better intermediate, near visual acuity and contrast sensitivity in Enhanced Monofocal IOL group along with higher spectacle-independence and over-all patient satisfaction.

Implantation of Enhanced Monofocal IOL in patients with cataract and previous kerato-refractive surgery provided comparable uncorrected distance visual acuity as compared to standard monofocal IOL group. In addition, they provided significantly better distance-corrected Intermediate visual acuity and contrast sensitivity. In patients with cataract and previous kerato-refractive surgery, enhanced monofocal is a preferable option as compared to standard monofocal IOL.