Visual Performance And Quality Of Life Improvement After Combined Implantation Of Two Complementary Multifocal Intraocular Lenses

To evaluate our first clinical results and Quality-of-Life (QoL) performance on presbyopia correction during cataract surgery by implanting a complementary IOL system with 2 multifocal intraocular lenses (Symbiose Mid and Symbiose Plus, manufacturer Crystalens, France).

Department of Ophthalmology, Pallas Clinic, Zurich, Switzerland

Retrospective case study analysis of the first 30 eyes (15 patients, 62 ± 6.9 years) with a follow-up of at least 3 months. The Symbiosis Mid, which has a second main focus in the intermediate area, was implanted in the dominant eye and the Symbiosis Plus, which has its second main focus at near, was implanted in the non-dominant eye. 16 eyes were treated with femto-laser-assisted cataract surgery (FLACS), 10 patients underwent consecutive bilateral surgery, and a toric IOL was implanted in 14 eyes. The defocus equivalent (DEQ), astigmatism (Cyl), uncorrected distand (UDVA), intermediate (UIVA at 70-80cm) and near (UNVA at 30-40cm) visual acuity and the quality-of-life questionnaire Catquest-9SF) were evaluated and analyzed.

The DEQ could be reduced from preoperatively +0.93 ± 3.35 D (-7.25 - +6.25D) to -0.06 ± 0.31 D (-1.0 - +0.5 D), the Cyl from -0.85 ± 0.41 D (-2.0 - 0 D) to -0.46 ± 0.22 D (-0.75 – 0D). Binocular UDVA was ≥0.8 in 100% of eyes and ≥1.0 in 80%, UIVA was ≥0.8 in 93.3% and ≥1.0 in 60%, and UNVA was ≥0.8 in 93.3% and ≥1.0 in 53.3%. 40% of patients were generally quite satisfied with the operation and 60% were very satisfied. 40% reported seeing halos around light sources inmesopic conditions. 1 patient continues to wear reading glasses for small print and one for driving at night. Corneal laser enhancement has not yet been felt to be necessary.

Simultaneuous Implantation of the Symbiose IOL-System (Mid and Plus) offers good presbyopic correction in cataract patients and enables extensive spectacle independence for distance, intermediate and near vision. Patient satisfaction was high with acceptable dysphotopic light phenomena.