Long-Term Safety And Efficacy Of An Extended Macular Vision Intraocular Lens (Iol) Implanted In Patients With Macular Disease Undergoing Cataract Extraction, With A Focus On Results Of Visually Insignificant Cataract Eyes

To determine the long-term safety and efficacy of an extended macular vision intraocular lens (IOL) implanted in patients with macular disease undergoing cataract extraction, with a focus on results of visually insignificant cataract eyes.

Micro Chirurgia Oculare, Milan, Italy

A retrospective case series of patients undergoing phacoemulsification and implantation of an extended macular vision IOL designed to optimise image quality up to 10 degrees from the foveal centre (EyeMax Mono, Sharpview Ophthalmology, London, UK). Criteria for implantation: centre-involving macular lesion (e.g., dry AMD, stable wet AMD, macular hole, Stargardt disease), stable choroidal neovascularisation (no intra- or sub-retinal fluid) and no retinal treatment for 6 months prior to surgery. Criterion for exclusion: eyes without functioning retina within approximately 2 disc-diameters (10 degrees) of eccentricity from the foveal centre. Eyes were categorized in four groups depending on the cataract density: NC1, NC2, NC3, NC4

269 eyes of 215 patients (mean age 72.5±9.8 years) were included in the study and followed up for a mean of 46.1±25.6 months. Mean CDVA and CNVA improved by 0.26 logMAR (p<0.001) and by 0.15 logMAR (p<0.001), respectively. The subgroup of eyes with visually insignificant cataract (NC1) (n=147) showed a mean improvement in visual acuity: 0.22 logMAR of CDVA (11 ETDRS letters) (p<0.001) and 0.9 logMAR of CNVA (4 ETDRS letters) (p<0.001); 35.4% of those eyes gained ≥3 CDVA lines and 16.5% gained ≥3 CNVA lines. Hypermetropia was targeted in most eyes to provide magnification when corrected with spectacles. NC1 eyes with postoperative spherical equivalent <1D (n=12) had a mean CDVA improvement of 0.24 logMAR (p=0.003).

Visual improvement in patients with macular lesions who underwent cataract removal and were implanted with the EyeMax Mono IOL appears to be jointly influenced by the surgical removal of the cataract and the optical design of the IOL. Notably, the vision enhancement for eyes with visually insignificant cataracts underscores the IOL's ability to optimize the use of healthy retinal areas. Future research will evaluate the respective contributions of the IOL design and cataract surgery to the overall enhancement of visual function in this patient population.