Performance Of The Puresee Extended Depth Of Focus Intraocular Lens In High Myopic Post-Lasik Patients

To evaluate the performance of the non-diffractive extended depth of focus (EDOF) intraocular lens (IOL) PureSee™ (J&J) in two high myopic patients with cataracts who had previously undergone LASIK refractive surgery. The analysis includes uncorrected and corrected distance visual acuity at different distances, monocular and binocular defocus curves from +1.00 diopter (D) to -3.00 D, contrast sensitivity under photopic and mesopic conditions, and responses to the VFQ-14 quality of life questionnaire three months after surgery. Ethical considerations: This study adhered to the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Hospital Clínico San Carlos in Madrid under the protocol number 23/064-E.

This prospective observational study included 4 eyes from 2 patients implanted with the EDOF IOL PureSee™ following femtosecond laser-assisted phacoemulsification. The target postoperative refraction was emmetropia. The same experienced cataract surgeon at Hospital Universitario de Sanitas La Moraleja in Madrid, Spain, performed all procedures. Patients were followed for 3 months postoperatively.

Preoperative assessment included biometry performed with the IOLMaster 700 (Carl Zeiss Meditec, Jena, Germany). IOL power calculation used the post-myopic laser vision correction Barrett True-K formula to optimize refractive accuracy. Additionally, results were verified using the ESCRS online calculator. Patients were diagnosed with cataracts through slit-lamp biomicroscopy using the Yuratec RT 1000 (Carl Zeiss, Jena, Germany). Optical coherence tomography (OCT) with the Dri OCT Triton® (Topcon, Japan) was performed to rule out myopic maculopathy. The Oculus Pentacam was used to assess astigmatism and evaluate higher-order (HOA) and total (Z40) aberration parameters. Contrast sensitivity was measured using the CSV-1000 test.

The axial length was 30.55 mm in the right eye (RE) and 28.21 mm in the left eye (LE) for Patient 1 (P1), and 28.55 mm and 28.93 mm for Patient 2 (P2). Monocular uncorrected visual acuity (UCVA) in LogMAR: • P1: RE = 0.14, LE = 0.06 • P2: RE = 0.0, LE = 0.1 Best-corrected visual acuity (BCVA) in LogMAR: • P1: RE = 0.14, LE = 0.0 • P2: RE = 0.0, LE = 0.1 Binocular uncorrected intermediate visual acuity (BUIVA): • P1: 0.06 • P2: 0.2 Binocular uncorrected near visual acuity (BUNVA): • P1: 0.22 • P2: 0.3 Regarding the monocular defocus curve with best spectacle correction for distance: • At intermediate vision (-1.5 D): o P1: RE = 0.14, LE = 0.3 o P2: RE = 0.2, LE = 0.3 • At near vision (-2.5 D): o P1: RE = 0.3, LE = 0.6 o P2: RE = 0.6, LE = 0.6

• PureSee EDOF IOL in high myopic post-LASIK patients may represent a viable option, offering a good balance between visual quality and spectacle independence. However, specific biometric adjustments should be considered to optimize outcomes, especially for near vision, showing a decrease in performance observed in the defocus curve with best spectacle correction. • Both patients were satisfied or very satisfied with their uncorrected vision at all distances and would choose the same intraocular lens again.