1Stq Add-On Multifocal Implant In Pseudophakic Patients, Liberty2 For Phakic Patients

1stQ Add-on implant is a secondary implant that can be safely placed in the sulcus as a piggy-back on top of a monofocal implant in the bag. Liberty2 is a dual lens implantation (one IOL in the bag and an Addon in the sulcus). It provides a reversible alternative in correcting postsurgical ametropia, dysphotopsia, or providing multifocality in a monofocal pseudophakic after cataract or lens refractive surgery. It can be explanted if the multifocality is not tolerated or in case of the development of diseases contraindicating a multifocal implant.The aim of this study is to provide multifocality to the pseudophakic patient operated with monofocal IOL or to correct the residual postoperative error.

The study is conducted at Hubert Vision private practice, 26 Rue de la Porte Neuve, 6700 Arlon, all patients have been operated in the private theater facility by Dr Cristina Hubert.

This is a prospective single site, single surgeon study. 5 patients, 2 males and 3 females with a total of 8 eyes (2 phakic and 6 pseudophakic), 1 unilateral implantation (with Liberty square system implanted after the cataract surgery in a phakic eye for high refractive error with no choice of toric multifocal IOL available), 4 bilateral implantations in the same day surgery in pseudophakic patients (2 patients pseudophakic monofocal, 1 patient had one Liberty2 during cataract surgery in a phakic eye and 1 Addon in his second pseudophakic eye, 1 patient had a multifocal IOL in one eye and Addon on the second monofocal pseudophakic eye). All Addons were multifocal, 3 toric; 2 pseudophakic eyes had toric IOL before implantation.

UCVA improved in all patients at all distances. No additional glasses were needed. There were no intraoperative or postoperative complications, 1 patient presented avec one haptic over the iris and placed back next day, 2 patients had higher IOP well controlled with treatment (one developed it after the implantation, one was already treated before the surgery). 3 patients developed secondary cataract and were proposed for YAG capsulotomy several months after the surgery. 4 patients were known with dry eyes, and were treated. The associated pathology was high myopia in 2 patients, 3 patients had diabetes, 2 patients developped retinal disease in one eye. No patient needed explantation because of intolerance or disease.

1stQAddon multifocal implant is a good choice of IOL and provides multifocality and glasses independence, in a previously operated pseudophakic patient. Liberty2 has been used in patients during cataract surgery who wanted the multifocality but also to have an alternative to reverse to a monofocal lens in case of lack of neuroadaptation or disease. Same day bilateral surgery for Addon implantation is safe, efficient, and comfortable for the patient.