Clinical Results and Optical Quality of Diffractive Multifocal IOL Implantation after Myopic Refractive Surgery

Jae Hong Park; Dong Seob Ahn; Sang Jeong Moon; Dong Jun Lee; Sang Youp Han; Kyung Heon Lee

doi:10.3341/jkos.2014.55.12.1779

Journal List > J Korean Ophthalmol Soc > v.55(12) > 1009858

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Park, Ahn, Moon, Lee, Han, and Lee: Clinical Results and Optical Quality of Diffractive Multifocal IOL Implantation after Myopic Refractive Surgery

Original Article

J Korean Ophthalmol Soc 2014;55(12):1779-1786.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.12.1779

Clinical Results and Optical Quality of Diffractive Multifocal IOL Implantation after Myopic Refractive Surgery

Jae Hong Park, MD, Dong Seob Ahn, MD, Sang Jeong Moon, MD, Dong Jun Lee, MD, Sang Youp Han, MD, Kyung Heon Lee, MD

Busan Sungmo Eye Hospital, Busan, Korea

Address reprint requests to Sang Jeong Moon, MD Busan Sungmo Eye Hospital, #409-1 Haeundae-ro, Haeundae-gu, Busan 612-823, Korea, Tel: 82-51-743-0775, Fax: 82-51-743-0776, E-mail: pinmed@hanmail.net

Received 26 April 2014 Revised 11 August 2014 Accepted 17 November 2014

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 evaluate the visual outcome and optical quality in eyes with diffractive multifocal intraocular lens (DMIOL) implantation after myopic refractive surgery.

Methods

Nineteen eyes (15 patients) were implanted with AcriSof ReSTOR® SN6AD1, the aspheric DMIOL after myopic refractive surgery (laser-assisted in situ keratomileusis [LASIK] 14 eyes, photorefractive keratectomy [PRK] 4 eyes, laser-assisted subepithelial keratomileusis [LASEK] 1 eye). Preoperative and postoperative visual acuities and manifest refraction were measured. Preoperative corneal higher-order aberrations (HOAs) were measured using Hartmann-Shack (H-S) aberrometer in dilated pupils, and optical qualities were measured 1 month postoperatively using H-S aberrometer and a double-pass system under mesopic conditions. Patient satisfaction was investigated using a questionnaire at 2 months postoperatively.

Results

Uncorrected distant and near visual acuities at postoperative 2 months were 0.11 ± 0.19, and 0.19 ± 0.12 (log MAR), respectively. Postoperative spherical equivalent (SE) of 16 eyes (84.2%) was within ±0.50 diopters (D) and all eyes were within ±1.00 D from emmetropia. Preoperative corneal and postoperative ocular spherical aberrations in a 4.0 mm pupil diameter were 0.08 ± 0.08 and 0.07 ± 0.07 (µm), respectively. Objective scatter index was 3.42 ± 1.71 and modulation transfer function (MTF) cut-off value was 21.03 ± 12.37 cpd. General satisfaction score was 3.52 ± 0.96 points out of 5, and 8 patients (11 eyes) were not satisfied with DMIOL implantation.

Conclusions

After DMIOL implantation in the eyes with previous myopic refractive surgery, postoperative SE was close to the target D, but optical qualities and patient satisfaction were poor.

Keywords: Aspherical diffractive multifocal intraocular lens, Higher-order aberration, Myopic refractive surgery, Optical quality

References

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Figure 1.

Visual acuity after the diffractive multifocal intraocular lens (IOL) implantation. (A) Uncorrected distance visual acuity (UDVA). (B) Uncorrected near visual acuity (UNVA).

Figure 2.

Postoperative spherical equivalent of the patients who had implanted the diffractive multifocal intraocular lens (IOL).

Table 1.

Demographic data of the patients with diffractive IOL implantation after myopic refractive surgery

Characteristic	Values
Number of eyes (patients)	19 (15)
Age (years)	49.0 ± 6.78
Sex (M:F)	6:9
Preoperative SE (diopter)	−1.74 ± 2.52
Corrected distance VA (log MAR)	0.39 ± 0.28
K value (diopter)	37.17 ± 2.37
Axial length (mm)	26.70 ± 1.36
IOL power (diopter)	19.44 ± 1.77
Type of refractive surgery (eye, n)
LASIK	14
PRK	4
LASEK	1

Values are presented as mean ± SD unless otherwise indicated. IOL = intraocular lens; SE = spherical equivalent; VA = visual acuity; K value = keratometric value; LASIK = laser-assisted in situ keratomileusis; PRK = photorefractive keratectomy; LASEK = laser-assisted subepithelial keratomileusis.

Table 2.

Corneal/ocular aberrations (μm) before and after the diffractive IOL implantation

	Corneal/ocular	Pupil size	Total HOA	3rd HOA	4th HOA	Coma	SA
PreOP	Cornea	4 mm	0.24 ± 0.11	0.20 ± 0.10	0.12 ± 0.07	0.19 ± 0.11	0.08 ± 0.08
PreOP	Cornea	6 mm	0.85 ± 0.25	0.51 ± 0.24	0.64 ± 0.18	0.47 ± 0.24	0.58 ± 0.15
PostOP 1 M	Cornea	4 mm	0.26 ± 0.09	0.22 ± 0.09	0.13 ± 0.06	0.17 ± 0.09	0.08 ± 0.09
PostOP 1 M	Ocular	4 mm	0.26 ± 0.14	0.23 ± 0.15	0.12 ± 0.05	0.17 ± 0.12	0.07 ± 0.07

Values are presented as mean ± SD.

IOL = intraocular lens; HOA = higher-order aberration; SA = spherical aberration; M = month.

Table 3.

Postoperative visual acuity (log MAR) after the diffractive IOL implantation

	2 weeks	1 month	2 months
Distance
UDVA	0.11 ± 0.07	0.11 ± 0.10	0.11 ± 0.09
CDVA	0.04 ± 0.04	0.04 ± 0.05	0.03 ± 0.04
Near
UNVA	0.22 ± 0.10	0.21 ± 0.12	0.19 ± 0.12

Values are presented as mean ± SD.

IOL = intraocular lens; UDVA = uncorrected distance visual acuity; CDVA = corrected distance visual acuity; UNVA = uncorrected near visual acuity.

Table 4.

OQAS® results after at 1 month after the diffractive IOL implantation (n = 11)

Parameter	Values
OSI (OSI value)	3.43 ± 1.71
MTF cut-off (C/deg)	21.03 ± 12.37
Strehl ratio	0.13 ± 0.07
Width at 50% (arc min)	7.40 ± 3.63
Width at 10% (arc min)	27.48 ± 15.02

Values are presented as mean ± SD.

OQAS = optical quality analysis system; IOL = intraocular lens;

OSI = objective scatter index; MTF = modulation transfer function.

Table 5.

Patients’ satisfaction scores at 2 months after the diffractive IOL implantation

Categories	Values
General	3.52 ± 0.96
Distant VA	3.36 ± 0.76
Intermediate VA	3.68 ± 0.67
Near VA	3.31 ± 1.05

Values are presented as mean ± SD.

IOL = intraocular lens; VA = visual acuity.

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