Management Of Hyperopic Residual Refraction After Trifocal Iol Implantation With Positive Meniscus–Shaped Lenticule Transplantation
Published 2026 - 44th Congress of the ESCRS
Reference: FP23.03 | Type: Free paper | DOI: 10.82333/wejd-tv86
Authors: Ms Ceren Ece Semiz* 1 , Faruk Semiz 1 , Fetih Furkan Arslan 2 , Gökçe İdil Semiz 1 , Njomza Hima Musa 1
1Eye Hospital,Prishtina,Kosovo, 2Ophthalmology,Cerrahpaşa-Istanbul University,Istanbul,Türkiye
Purpose
To evaluate the safety and efficacy of positive meniscus–shaped lenticule transplantation for the correction of residual hyperopia and presbyopia in pseudophakic patients following trifocal intraocular lens (IOL) implantation
Setting
Eye Hospital, Prishtina, Kosovo
Methods
32 pseudophakic patients (64 eyes; mean age 54.8 ± 5.8 years) with residual hyperopia (+0.75 to +1.75 D) and astigmatism (+0.50 to +1.25 D) after trifocal IOL implantation underwent allogeneic positive meniscus–shaped lenticule transplantation. Donor lenticules (mean thickness 43.52 ± 7.22 µm), obtained from SMILE procedures, were selected at +0.50 D above the residual spherical error. A femtosecond laser–created 130-µm stromal pocket was used for implantation. The primary outcome was change in uncorrected distance visual acuity (UDVA); secondary outcomes included UNVA, manifest refraction, keratometry, Q-value, central corneal thickness (CCT), higher-order aberrations (RMS), and complication rates. Minimum follow-up was 12 months.
Results
UDVA improved from 0.35 ± 0.20 to 0.003 ± 0.01 logMAR (p < 0.001). Sphere decreased from +1.20 ± 0.28 to −0.33 ± 0.30 D and cylinder from +0.92 ± 0.32 to 0.37 ± 0.13 D (p < 0.001). UNVA improved from J6 to J2 (40 cm) and J6 to J3 (80 cm). CCT increased from 500.39 ± 18.88 to 543.66 ± 19.37 µm (p < 0.001). Keratometry increased (K1: 41.02 → 43.52 D; K2: 41.98 → 43.88 D), and Q-value shifted toward greater prolateness (−0.41 → −0.59). RMS increased (0.84 ± 0.14 → 1.88 ± 0.36 µm), while CDVA remained stable without ≥1-line loss. No intra- or postoperative complications occurred, and ≥80% achieved spectacle independence.
Conclusions
Positive meniscus–shaped lenticule transplantation provides a safe, tissue-preserving, and reversible corneal enhancement strategy for managing residual hyperopia and presbyopia after trifocal IOL implantation. Controlled modulation of corneal asphericity contributes to improved functional vision across distances while maintaining safety.