Evaluation Of The Efficacy, Safety, And Postoperative Positioning Of Supplementary Multifocal Intraocular Lenses Implanted In The Ciliary Sulcus

With advancements in cataract surgery, supplementary intraocular lenses (IOLs) have emerged as an alternative to enhance presbyopia correction while maintaining reversibility and minimizing intraoperative risks. This study aimed to evaluate the efficacy, safety, and postoperative positioning of the 1stQ AddOn® IOL implanted in the ciliary sulcus of pseudophakic patients in the Brazilian population. Additionally, the correlation between preoperative biometric parameters and postoperative vault measurements was assessed to determine their predictive value for optimal IOL positioning.

This study was conducted at a tertiary ophthalmology center in Brazil, specializing in cataract and refractive surgery. Patients underwent surgical procedures performed by experienced surgeons following standardized protocols. Preoperative and postoperative assessments were carried out using advanced imaging and biometry technologies, including IOLMaster and Pentacam. The study adhered to ethical guidelines and was approved by an institutional review board.

This study included 28 eyes of 14 patients who underwent phacoemulsification with implantation of a monofocal IOL in the capsular bag, followed by implantation of a supplementary 1stQ AddOn® IOL in the ciliary sulcus during the same surgical session. Postoperative assessments were conducted at five time points (1 day, 1 week, 30 days, 3 months, and 6 months), and included visual acuity, refraction, intraocular pressure (IOP), IOL positioning, vault measurement, contrast sensitivity, and complication analysis. A correlation analysis between preoperative biometric parameters (ACD IOL, ACD Pentacam, WTW, S-S, A-A) and postoperative vault was performed using linear regression and machine learning models.

The mean postoperative uncorrected distance visual acuity (UDVA) was 0.04 ± 0.19 logMAR, with 25 eyes achieving 0.00 logMAR, 2 eyes achieving 0.10 logMAR, and 1 eye with 1.00 logMAR. Uncorrected near visual acuity (UNVA) was 0.03 ± 0.10 logMAR, with 26 eyes achieving J1, 1 eye J3, and 1 eye J6. The most common complication was inverted IOL (5 cases, 17.24%), followed by haptic misplacement (3 cases, 10.34%) and torn haptic (2 cases, 6.90%). ACD Pentacam showed the strongest correlation with vault (r = 0.36). Predictive models had low accuracy, suggesting that preoperative biometric variables alone are insufficient to predict final vault.

The implantation of the 1stQ AddOn® IOL resulted in good postoperative visual outcomes, with most patients achieving excellent distance and near vision. Despite a low incidence of complications, precise intraoperative handling remains essential to minimize risks. Additionally, preoperative biometric parameters demonstrated limited predictive value for postoperative vault, suggesting that other factors may influence final IOL positioning.