Clinical Outcomes of Patients with Refractive Aspheric Multifocal IOL Implantation

Sung Yu; Jee Hyun Kim; Gwang Ja Lee; Kyoo Won Lee; Young Jeung Park

doi:10.3341/jkos.2014.55.7.991

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Yu, Kim, Lee, Lee, and Park: Clinical Outcomes of Patients with Refractive Aspheric Multifocal IOL Implantation

Original Article

J Korean Ophthalmol Soc 2014;55(7):991-1000.

Published online: 30 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.7.991

Clinical Outcomes of Patients with Refractive Aspheric Multifocal IOL Implantation

Sung Yu, MD, Jee Hyun Kim, MD, Gwang Ja Lee, MD, Kyoo Won Lee, MD, PhD, Young Jeung Park, MD, PhD

Cheil Eye Hospital, Daegu, Korea

Address reprint requests to Young Jeung Park, MD, PhD, Cheil Eye Hospital, #1 Ayang-ro, Dong-gu, Daegu 701-820, Korea, Tel: 82-53-959-1751, Fax: 82-53-959-1758 E-mail: Eyepark9@naver.com

Received 17 January 2014 Revised 11 March 2014 Accepted 24 June 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 clinical outcomes of patients with refractive aspheric multifocal intraocular lens (IOL) (Lentis Mplus® LS-313) implantation.

Methods

Sixty-eight eyes of 53 patients received refractive aspheric multifocal IOL implantation. Uncorrected visual acuity (UCVA) at a long distanc, as well as intermediate and near distances were measured on the first day, after two weeks, and during the first, third and sixth months postoperatively. Optical quality was evaluated using the Optical Quality Analysis System II (OQAS II). High-order aberrations (HOA) and patient satisfaction questionnaires were evaluated at three months post-operation.

Results

At the six-month postoperative visit, the mean UCVA at a long, two intermediate (63 cm, 100 cm) and a near distance were 0.06 ± 0.07, 0.18 ± 0.14, 0.15 ± 0.13 and 0.11 ± 0.10 log MAR, respectively. The means of the objective scatter index, modulation transfer function (MTF) cut off value, Strehl ratio and pseudo-accommodation range measured by OQAS II were 1.20 ± 0.69, 34.15 ± 9.53 cdp, 0.17 ± 0.05 and 3.09 ± 0.25 D, respectively. HOA of 5 mm and 6 mm were each 0.61 ± 0.14 and 1.07 ± 0.20, respectively. Eighty-two percent of patients were satisfied with the postoperative results, and 71% of the patients reported that they would recommend the procedure to others, while 24% of patients reported moderate or severe visual disturbance at night.

Conclusions

Implantation of the refractive aspheric multifocal IOLs in patients with cataracts provided excellent distant, intermediate, and near visual outcomes and high patient satisfaction as well as presbyopia correction.

Keywords: Cataract, Lentis Mplus, Multifocal intraocular lens, Satisfaction

References

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Figure 1.

The aspheric refractive multifocal intraocular lens (IOL) (Lentis Mplus® LS-313).

Figure 2.

An example of a patient's image quality with accommodation measured by optical quality analysis system II at post-operative 3 months. The graph shows a wider range of optical quality (0.0-2.0 D). At the 3-month postoperative visit, the mean pseudo-accommodation range of total enrolled patients was 3.09 ± 0.25 D.

Figure 3.

Satisfaction of the patients with the refractive multifocal intraocular lens (IOL) (%)

Table 1.

Patient demographics and clinical information

Parameter	Values
Eyes (n)	68
Patients (n)	53
Sex (M:F)	33:20
Age (years) (range)	55.5 ± 8.8 (35-76)
UDVA (log MAR)	0.53 ± 0.37
Spherical equivalent (diopter)	-1.16 ± 3.14
Mean IOL power (diopter)	18.29 ± 3.38

Values are presented as mean ± SD.

UDVA = uncorrected distance visual acuity; IOL = intraocular lens.

Table 2.

Postoperative visual acuity over time after implantation of the Lentis Mplus® LS 313

Post op	1 day	2 weeks	1 month	3 months	6 months
UDVA (log MAR)	0.11 ± 0.13	0.07 ± 0.09	0.07 ± 0.09	0.07 ± 0.09	0.06 ± 0.07
CDVA (log MAR)	0.05 ± 0.07	0.04 ± 0.07	0.02 ± 0.05	0.03 ± 0.05	0.02 ± 0.04
UNVA (log MAR)	0.15 ± 0.12	0.10 ± 0.09	0.11 ± 0.11	0.11 ± 0.10	0.11 ± 0.10
UIVA63 (log MAR)	0.16 ± 0.13	0.16 ± 0.12	0.17 ± 0.20	0.17 ± 0.12	0.18 ± 0.14
UIVA100 (log MAR)	0.17 ± 0.13	0.13 ± 0.11	0.13 ± 0.12	0.13 ± 0.13	0.15 ± 0.13

Values are presented as mean ± SD.

UDVA = uncorrected distance visual acuity; CDVA = corrected distance visual acuity; UNVA = uncorrected near visual acuity at 40 cm distance; UIVA63 = uncorrected intermediate visual acuity at 63 cm distance; UIVA100 = uncorrected intermediate visual acuity at 100 cm distance; post op = post operative.

Table 3.

Refractive value (diopter) at post op 1 day, 1 week, 1, 3 and 6 months

Post op	1 day	2 weeks	1 month	3 months	6 months
MR	-0.14 ± 0.37	-0.08 ± 0.35	-0.09 ± 0.36	-0.11 ± 0.38	-0.03 ± 0.39
AR	-1.27 ± 0.44	-1.33 ± 0.40	-1.23 ± 0.49	-1.11 ± 0.54	-0.94 ± 0.48

Values are presented as mean ± SD.

Post op = post operative; MR = manifest refraction; AR = auto refraction.

Table 4.

Optical quality parameters measured by optical quality analysis system II at post-op 3 months

Parameter	Mean score ± SD
OSI	1.20 ± 0.69
MTF cut off value (cpd)	34.15 ± 9.53
Strehl ratio	0.17 ± 0.05

OSI = objective scatter index; MTF = modulation transfer function; post op = post operative.

Table 5.

Ocular aberrometry analysis measured by Zywave II® at post-op 3 months

	Values (μm)		Values (μm)
HOA 5 mm	0.61 ± 0.14	HOA 6 mm	1.07 ± 0.20
Trefoil	0.32 ± 0.18	Coma	0.39 ± 0.17
Quadrafoil	0.10 ± 0.08	2nd astigmatism	0.08 ± 0.07
Spherical aberration	0.27 ± 0.14	Pentafoil	0.07 ± 0.04
2nd trefoil	0.05 ± 0.04	2nd coma	0.04 ± 0.03

Values are presented as mean ± SD.

HOA = high order aberration; post op = post operative.

Table 6.

Visual acuity and OQAS values after implantation of Lentis Mplus® LS 313 in post-LASIK patients at post-op 3 months

	Values		Values
MR	-0.16 ± 0.52	OSI	2.03 ± 1.50
UDVA	0.14 ± 0.09	MTF cut off (cpd)	29.53 ± 12.88
CDVA	0.05 ± 0.09	Strhel ratio	0.15 ± 0.02
UNVA	0.06 ± 0.06
UIVA63	0.13 ± 0.12
UIVA100	0.17 ± 0.15

Values are presented as mean ± SD.

OQAS II = optical quality analysis system II; MR = manifest refraction; UDVA = uncorrected distance visual acuity; CDVA = corrected distance visual acuity; UNVA = uncorrected near visual acuity at 40 cm distance; UIVA63 = uncorrected intermediate visual acuity at 63 cm distance; UIVA100 = uncorrected intermediate visual acuity at 100 cm distance; OSI = objective scatter index; MTF = modulation transfer function; post-LASEK = post laser-assisted in situ keratomileusis; post op = post operative.

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