Non-Diffractive Full Depth-Of-Field (Full-Dof) Toric Intraocular Lens With A Continuous Defocus Profile For Severe Anisometropia In A Young Patient With Previous Strabismus Surgery: A Case Report

To report functional visual and binocular outcomes after unilateral refractive lens exchange with implantation of a non-diffractive Full Depth-of-Field (Full-DoF) toric multifocal intraocular lens (mIOL) with a continuous defocus profile in a young patient with severe anisometropia and previous strabismus surgery, for whom contact lenses and spectacles were poorly tolerated, and corneal laser refractive surgery and phakic intraocular lenses were contraindicated.

Single-site private ophthalmic practice.

A 33-year-old woman presented with severe anisometropia and a history of right-eye strabismus surgery performed in 2020. Postoperative evaluation showed residual right exotropia (approximately 12 prism diopters) associated with right hypotropia due to superior rectus hypofunction, without abnormal head posture. The patient reported no diplopia and stereopsis was absent. Contact lenses were discontinued due to intolerance with chronic conjunctival hyperaemia and ocular surface discomfort, and spectacle correction failed to provide functional rehabilitation. Corneal laser refractive surgery was contraindicated due to insufficient corneal thickness, and phakic IOL implantation was excluded due to anterior chamber depth <2.80 mm. Preoperative refraction showed high myopia in the right eye (CDVA 0.10 logMAR; -12.75 sphere and -3.50 cylinder at 170°) and minimal refractive error in the dominant left eye (UDVA 0.00 logMAR). Unilateral refractive lens exchange was performed with implantation of a non-diffractive Full Depth-of-Field toric multifocal IOL with continuous defocus profile (RayOne Galaxy Toric IOL; +8.00 sphere and +3.00 cylinder), with image-guided axis alignment. At 1 month, ocular alignment was orthophoric at distance and near, binocular UDVA was 0.00 logMAR and UNVA was J3. No diplopia or clinically relevant photic phenomena were reported. Stereopsis improved to 40 arcseconds on TNO testing. Outcomes remained stable at 3 and 6 months.

This case demonstrates that unilateral refractive lens exchange with implantation of a non-diffractive Full Depth-of-Field toric multifocal intraocular lens can achieve effective visual rehabilitation and high patient satisfaction using mIOL in a young patient with severe anisometropia and previous strabismus surgery when alternative refractive options are contraindicated. Continuous depth of field without reliance on diffractive multifocality or monovision may reduce binocular stress and limit complications and side effects of mIOL in compromised binocular function. Careful binocular assessment, image-guided axis alignment, and structured follow-up were critical to achieve stable binocular balance and durable outcomes.