Comparison Of Fundus Visualization Through Different Intraocular Lenses During Vitreoretinal Surgery

Reduced fundus visibility during vitreoretinal surgery has been reported with multifocal intraocular lenses (IOLs). As various IOLs with different optical designs are currently used in clinical practice, this study aimed to compare and quantitatively evaluate intraoperative fundus visibility among different IOL models.

Experimental laboratory study

A fundus observation model was constructed using a Gullstrand model eye. The evaluated IOLs were CNA0T0, CNAET0, and CNATT0 (Alcon) and XY1, XY1-EM, and XY1-G (HOYA). A USAF 1951 resolution target was placed at the posterior pole of the model eye. Each IOL was fixed in a holder filled with distilled water and imaged under a surgical microscope. The images were analyzed using ImageJ, and contrast differences in the three-line patterns were quantified.

Among the Alcon IOLs, resolution was highest with CNA0T0, followed by CNAET0 and CNATT0. Among the HOYA IOLs, resolution was highest with XY1, followed by XY1-EM and XY1-G. The measured values were 33.1 ± 1.6 for CNA0T0, 19.3 ± 2.4 for CNAET0, 11.3 ± 5.6 for CNATT0, 32.1 ± 3.0 for XY1, 28.6 ± 2.4 for XY1-EM, and 25.0 ± 15.1 for XY1-G. CNA0T0, XY1, and XY1-EM showed significantly higher values (P < 0.01).

Differences in optical design affected fundus visibility during vitreoretinal surgery. When selecting multifocal IOLs for patients who may require vitreoretinal surgery or have macular disease, the potential impact on intraoperative fundus visibility should be considered.