Refractive Lens Exchange With Trifocal Intraocular Lenses In Adult Patients With Mild To Moderate Amblyopia: Ten-Year Outcomes And Subjective Satisfaction

To evaluate 10-year visual outcomes, including patient-reported satisfaction after refractive lens exchange (RLE) with trifocal intraocular lens (IOL) implantation in adults with mild to moderate amblyopia. 

Lexum Eye Clinics, Prague, Czech Republic (surgeries performed between 2014-2015).

Our study included 29 eyes of 29 patients (mean age 55±7 years; range 43-68 years) with unilateral amblyopia who underwent RLE with bilateral implantation of trifocal lenses. Implanted IOLs were AT LISA tri 839MP (Carl Zeiss Meditec) and FineVision Micro F (PhysIOL), including toric versions. Inclusion criteria for trifocal IOL implantation in the amblyopic eye were corrected distance visual acuity ≥0.4 logMAR and near visual acuity ≥0.48 logMAR. Mean follow-up was 10 years. Outcome measures included uncorrected and corrected distance (UDVA, CDVA), intermediate, near visual acuity (UNVA, CNVA), refraction, postoperative defocus curve, and contrast sensitivity. Subjective patient satisfaction was evaluated using two types of questionnaires.

Mean spherical equivalent in studied amblyopic eyes changed from 3.27 ± 3.19 D before surgery to -0.16 ± 0.56 D at 10 years. UDVA improved from 0.91 ± 0.30 logMAR to postoperative 0.29 ± 0.16 logMAR (P < .0001). Mean CDVA remained stable (0.19 ± 0.08 logMAR preoperatively vs 0.18 ± 0.10 logMAR postoperatively). Preoperative CNVA was 0.18 ± 0.12 logMAR and postoperative UNVA was 0.23 ± 0.15 logMAR. Defocus curve corresponded to a trifocal profile. Contrast sensitivity was reduced in amblyopic eyes but remained within normal limits. Based on questionnaire outcomes, patients reported stable long-term satisfaction with visual performance.

Long-term results of our study demonstrate that refractive lens exchange with trifocal IOL implantation in carefully selected amblyopic patients can significantly improve uncorrected visual acuity and may enhance binocular function. High level of subjective satisfaction further supports the viability of trifocal IOLs in this traditionally excluded population.