Combined Implantation of Monofocal and Multifocal Intraocular Lenses in Senile Cataract Surgery

Ji Hyun Kim; Jun Won Lee; Jae Lim Chung; Eung Kweon Kim; Tai-Im Kim

doi:10.3341/jkos.2009.50.11.1632

Journal List > J Korean Ophthalmol Soc > v.50(11) > 1008411

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Kim, Lee, Chung, Kim, and Kim: Combined Implantation of Monofocal and Multifocal Intraocular Lenses in Senile Cataract Surgery

Original Article

J Korean Ophthalmol Soc 2009;50(11):1632-1638.

Published online: 31 August 2009

DOI: https://doi.org/10.3341/jkos.2009.50.11.1632

Combined Implantation of Monofocal and Multifocal Intraocular Lenses in Senile Cataract Surgery

Ji Hyun Kim, MD, Jun Won Lee, MD, Jae Lim Chung, MD, Eung Kweon Kim, MD, Tai-Im Kim, MD, PhD

The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

Address reprint requests to Tae-Im Kim, MD, PhD, Department of Ophthalmology, Yonsei University College of Medicine #134 Sinchon-dong, Seodaemun-gu, Seoul 120-752, Korea Tel: 82-2-2228-3570, Fax: 82-2-312-0541, E-mail: tikim@yumc.yonsei.ac.kr

Received 20 February 2009 Accepted 4 August 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To assess binocular visual outcomes in patients who were implanted with a monofocal IOL (intraocular lens) in one eye and a multifocal IOL in the contralateral eye or with a bilateral multifocal IOL.

Methods

This study enrolled 15 patients (30 eyes) implanted with a monofocal IOL in one eye and a multifocal IOL in the contralateral eye (5 patients, group 1) or with a bilateral multifocal IOL (10 patients, group 2). Binocular visual acuity (uncorrected/best distance corrected near, intermediate, and distance vision), binocular uncorrected reading speed, and contrast sensitivity were assessed at 6 months following the last implantation. Patient's quality of life (overall satisfaction, halos and glare presence, and spectacle dependence) was also assessed using a questionnaire at 6 months postoperatively.

Results

There was significant difference in the uncorrected and corrected near visual acuity between the 2 groups in the mesopic condition. There was no significant difference in visual acuity, reading speed and contrast sensitivity in other conditions between the 2 groups. Spectacle dependence rate was 60% in group 1 and 20% in group 2. The glare symptom was present in 60% of patients in both groups and the halo symptom was present in 3 out of 10 patients in group 2. Overall satisfaction score was not significantly different between the groups.

Conclusions

The combined implantation of a monofocal and a multifocal lens revealed similar visual outcomes compared to bilateral multifocal IOL implantation except for near vision. In addition, the results showed similar patient satisfaction in both groups.

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Keywords: Cataract surgery, Combined implantation, Multifocal intraocular lens

References

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Figure 1.

Mean binocular postoperative visual acuities of 2 groups at photopic condition (A) and mesopic condition (B). There was significant difference in the uncorrected (UCNVA) (p=0.048, Mann-Whitney U test) and corrected near visual acuity (BCNVA) (p=0.027, Mann-Whitney U test) between two groups only in the mesopic condition (B).^* Statistically significant in Mann-Whitney test (p<0.05). UCNVA=uncorrected near visual acuity; UCIVA=uncorrected intermediate visual acuity; UCFVA=uncorrected far visual acuity; BDCNVA=best distance corrected near visual acuity; BDCIVA=best distance corrected intermediate visual acuity; BDCFVA=best distance corrected far visual acuity.(Group 1=combined implantation; Group 2=bilateral multifocal implantation)

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Figure 2.

Postoperative binocular reading speed results in the 2 groups at 6 Months. There was no statistically significant difference between the 2 groups.

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Figure 3.

Contrast sensitivity test in the 2 groups at photopic condition (A) and mesopic condition (B). There was no statistically significant difference between the 2 groups.

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Table 1.

Type of intraocular lens in the 2 groups

		Intraocular lens
Group 1	Patient 1-1	SA60AT	ZM900
	Patient 1-2	SN60WF	ZM900
	Patient 1-3	SN60WF	ZM900
	Patient 1-4	SA60AT	ZM900
	Patient 1-5	SN60WF	ZM900
Group 2	Patient 2-1	ZM900	ZM900
	Patient 2-2	ZM900	ZM900
	Patient 2-3	ZM900	ZM900
	Patient 2-4	ZM900	ZM900
	Patient 2-5	ZM900	ZM900
	Patient 2-6	ZM900	ZM900
	Patient 2-7	ZM900	ZM900
	Patient 2-8	ZM900	ZM900
	Patient 2-9	ZM900	ZM900
	Patient 2-10	ZM900	ZM900

Group 1=combined intraocular lens implantation

Group 2=bilateral multifocal intraocular lens implantation

ZM900 (Tecnis, Advanced Medical Optics Inc., Santa Ana, Calif)

SA60AT, SN60WF (AcrySof, Alcon Laboratories Inc., Dallas, TX).

Table 2.

Preoperative characteristics of participants

	Group 1	Group 2	p-value
No. of patients	5	10	−
No. of eyes	10	20	−
Age (yr) mean (± SD)	65.50 (±1.29)	65.50 (±7.19)	0.864
Gender (M/F)	2/3	3/7	0.547
SE^* mean (± SD)	+1.25 (±0.35)	+1.62 (±0.77)	0.547
UCVA^† mean (± SD)	0.40 (±0.07)	0.30 (±0.19)	0.494

^*SE=spherical equivalent

^†UCVA=uncorrected visual acuity; Group 1=combined implantation; Group 2=bilateral multifocal implantation.

Table 3.

Subjective function scores in the 2 groups

	Group 1	Group 2	p-value
Patients' overall satisfaction Mean (± SD)	3.50±1.29	3.88±0.64	0.583
Halos No. of cases (%)	0/5 (0%)	3/10 (30%)	0.491
Glare No. of cases (%)	3/5 (60%)	6/10 (60%)	1.000
Complete spectacle independence No. (%)	2/5 (40%)	8/10 (80%)	0.067

Group 1=combined implantation; Group 2=bilateral multifocal implantation.

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