Outcomes After Diffractive Multifocal Toric IOL Implantation
Outcomes After Diffractive Multifocal Toric IOL Implantation
Patient's age in the analysed sample ranged from 37 to 84 years, with a mean value of 58.6±10.9 years (mean±SD). Mean preoperative axial length was 23.63±1.96 mm (range 20.05–28.49 mm) and mean anterior chamber depth 3.24±0.49 mm (range 2.28–4.30 mm). Mean preoperative corneal astigmatism was 1.92±0.75 D (range, 0.78–3.63 D), with 6 eyes (10.5%) with a value below 1 D, 29 eyes (50.9%) with a value between 1 and 2 D and 22 eyes (38.6%) with a corneal astigmatism higher than 2 D. Astigmatic location were in 21% with the rule, 56% against the rule and 23% oblique astigmatism.
In the overall sample, monocular logMAR CDVA improved from 0.20±0.19 (range, −0.10 to 1.00) preoperatively to 0.02±0.08 (range −0.20 to 0.30) postoperatively (p<0.01) (Table 1 and Table 2). At the final examination logMAR monocular UDVA was 0.12±0.16 (range −0.10 to 0.70) and logMAR binocular UDVA was 0.04±0.10 (range −0.10 to 0.40) (Table 1 and Table 2). Postoperative monocular logMAR UDVA was 0.20 or better in 85.4% of eyes and 0.30 or better in 91.7% (Table 3). In agreement with this postoperative level of UDVA, a significant reduction was observed in manifest cylinder with surgery (p<0.01).
Regarding near visual outcomes, logMAR monocular UNVA was 0.10±0.14 (range −0.10 to 0.60) and binocular UNVA was 0.06±0.12 (range −0.10 to 0.49) at 1 month postoperatively (Table 2). LogMAR monocular CNVA was 0.08±0.14 (range −0.10 to 0.60) and binocular CNVA was 0.03±0.09 (range −0.10 to 0.30) (Table 1 and Table 2). Postoperative monocular logMAR UNVA was 0.20 or better in 87.0% of eyes and 0.30 or better in 95.7% (Table 3). Concerning the intermediate vision, 1 month postoperative mean values of monocular and binocular logMAR UIVA of 0.21±0.13 (range −0.10 to 0.40) and 0.21±0.20 (range −0.10 to 0.40) were found (Table 2).
When outcomes were stratified for the implanted IOL model, no statistically significant differences were found between toric IOL model groups (p=0.11) in any of the visual and refractive parameters evaluated (Table 2). However, differences were found in the distribution of UDVA, UIVA and UNVA, as shown in table 3. Specifically, a lower percentage of eyes with UDVA and UNVA of 0.20 logMAR or better was found in the group of eyes implanted with the ZMT300 model (Table 3).
Regarding spectacle dependence, only 10.5% of patients from the sample asked for some degree of refractive correction for near and intermediate distance. Specifically, the best results were achieved with the implantation of the ZMT300 model (0% of spectacle dependence) while 22.2% of patients implanted with the model ZMT400 needed occasional correction for specific tasks (figure 1). Differences between toric IOL model groups in the postoperative rate of spectacle dependence (χ test, p=0.47) did not reach statistical significance.
(Enlarge Image)
Figure 1.
Postoperative incidence of photic phenomena and level of spectacle dependence.
When asking patients directly, 63.0% of the overall group reported about photic phenomena. Figure 1 displays the incidence of postoperative photic phenomena in the overall samples as well as divided by IOL group. There was no statistically significant difference found between the IOL groups (χ test, p=0.22). Most frequent photic phenomena were: 45.7% halos, 30.4% night glare, 13.0% day glare and 8.7% photophobia.
Regarding the ease of lens implantation, all surgeons assessed the procedure as easy or very easy (figure 2). Also, surgeons scored the use of the calculator as easy or very easy in almost all cases (figure 2). Regarding the ease of axis alignment (figure 2), it was defined as good or very good for all IOL models, only for the ZMT400 model was it moderate in 26.6% of the cases. The rate of overall satisfaction with the achievement of target refraction was high, with only 8% reporting a moderate or low satisfaction (figure 2). Specifically, all cases of low or very low satisfaction with achievement of target refraction were found in eyes implanted with the ZMT400 toric IOL (figure 2). Finally, the overall percentage of surgeon satisfaction with the procedure was 84%.
(Enlarge Image)
Figure 2.
Surgeon assessment of ease of calculator use, lens implantation, ease of axis alignment and achievement of target refraction in the overall sample.
Figure 3 shows the patient satisfaction with their uncorrected vision in the overall sample as well as divided by IOL model subgroup. As shown, 72.4% of patients were happy or very happy with the outcomes of the surgery and 20.7% reported to be moderately happy (figure 3).
(Enlarge Image)
Figure 3.
Patient satisfaction with uncorrected vision in the overall sample and also divided by intraocular lens group.
Results
Patient's age in the analysed sample ranged from 37 to 84 years, with a mean value of 58.6±10.9 years (mean±SD). Mean preoperative axial length was 23.63±1.96 mm (range 20.05–28.49 mm) and mean anterior chamber depth 3.24±0.49 mm (range 2.28–4.30 mm). Mean preoperative corneal astigmatism was 1.92±0.75 D (range, 0.78–3.63 D), with 6 eyes (10.5%) with a value below 1 D, 29 eyes (50.9%) with a value between 1 and 2 D and 22 eyes (38.6%) with a corneal astigmatism higher than 2 D. Astigmatic location were in 21% with the rule, 56% against the rule and 23% oblique astigmatism.
Visual and Refractive Outcomes
In the overall sample, monocular logMAR CDVA improved from 0.20±0.19 (range, −0.10 to 1.00) preoperatively to 0.02±0.08 (range −0.20 to 0.30) postoperatively (p<0.01) (Table 1 and Table 2). At the final examination logMAR monocular UDVA was 0.12±0.16 (range −0.10 to 0.70) and logMAR binocular UDVA was 0.04±0.10 (range −0.10 to 0.40) (Table 1 and Table 2). Postoperative monocular logMAR UDVA was 0.20 or better in 85.4% of eyes and 0.30 or better in 91.7% (Table 3). In agreement with this postoperative level of UDVA, a significant reduction was observed in manifest cylinder with surgery (p<0.01).
Regarding near visual outcomes, logMAR monocular UNVA was 0.10±0.14 (range −0.10 to 0.60) and binocular UNVA was 0.06±0.12 (range −0.10 to 0.49) at 1 month postoperatively (Table 2). LogMAR monocular CNVA was 0.08±0.14 (range −0.10 to 0.60) and binocular CNVA was 0.03±0.09 (range −0.10 to 0.30) (Table 1 and Table 2). Postoperative monocular logMAR UNVA was 0.20 or better in 87.0% of eyes and 0.30 or better in 95.7% (Table 3). Concerning the intermediate vision, 1 month postoperative mean values of monocular and binocular logMAR UIVA of 0.21±0.13 (range −0.10 to 0.40) and 0.21±0.20 (range −0.10 to 0.40) were found (Table 2).
When outcomes were stratified for the implanted IOL model, no statistically significant differences were found between toric IOL model groups (p=0.11) in any of the visual and refractive parameters evaluated (Table 2). However, differences were found in the distribution of UDVA, UIVA and UNVA, as shown in table 3. Specifically, a lower percentage of eyes with UDVA and UNVA of 0.20 logMAR or better was found in the group of eyes implanted with the ZMT300 model (Table 3).
Spectacle Dependence and Photic Phenomena
Regarding spectacle dependence, only 10.5% of patients from the sample asked for some degree of refractive correction for near and intermediate distance. Specifically, the best results were achieved with the implantation of the ZMT300 model (0% of spectacle dependence) while 22.2% of patients implanted with the model ZMT400 needed occasional correction for specific tasks (figure 1). Differences between toric IOL model groups in the postoperative rate of spectacle dependence (χ test, p=0.47) did not reach statistical significance.
(Enlarge Image)
Figure 1.
Postoperative incidence of photic phenomena and level of spectacle dependence.
When asking patients directly, 63.0% of the overall group reported about photic phenomena. Figure 1 displays the incidence of postoperative photic phenomena in the overall samples as well as divided by IOL group. There was no statistically significant difference found between the IOL groups (χ test, p=0.22). Most frequent photic phenomena were: 45.7% halos, 30.4% night glare, 13.0% day glare and 8.7% photophobia.
Surgeon Assessment and Patient Satisfaction
Regarding the ease of lens implantation, all surgeons assessed the procedure as easy or very easy (figure 2). Also, surgeons scored the use of the calculator as easy or very easy in almost all cases (figure 2). Regarding the ease of axis alignment (figure 2), it was defined as good or very good for all IOL models, only for the ZMT400 model was it moderate in 26.6% of the cases. The rate of overall satisfaction with the achievement of target refraction was high, with only 8% reporting a moderate or low satisfaction (figure 2). Specifically, all cases of low or very low satisfaction with achievement of target refraction were found in eyes implanted with the ZMT400 toric IOL (figure 2). Finally, the overall percentage of surgeon satisfaction with the procedure was 84%.
(Enlarge Image)
Figure 2.
Surgeon assessment of ease of calculator use, lens implantation, ease of axis alignment and achievement of target refraction in the overall sample.
Figure 3 shows the patient satisfaction with their uncorrected vision in the overall sample as well as divided by IOL model subgroup. As shown, 72.4% of patients were happy or very happy with the outcomes of the surgery and 20.7% reported to be moderately happy (figure 3).
(Enlarge Image)
Figure 3.
Patient satisfaction with uncorrected vision in the overall sample and also divided by intraocular lens group.
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