Dissatisfication After Multifocal Intraocular Lens Implantation in Taiwan Yu Wei Lin, MD (Presenting Author); Ching-Ju Hsieh; Lin-Chung Woung The authors.

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Dissatisfication After Multifocal Intraocular Lens Implantation in Taiwan Yu Wei Lin, MD (Presenting Author); Ching-Ju Hsieh; Lin-Chung Woung The authors have no financial interests to disclose.

Design and Participants This was a one-year prospectively comparative clinical study. Patients with IOL implantation were divided two groups based on the types of IOL as follows: multifocal (AcrySof ReSTOR, Tecnis ZM900, & ReZoom). monofocal (Acrysof SA60AT, & Sensar AR40e). Purpose To compare the reasons for patients’ dissatisfaction after bilateral implantation of multifocal versus monofocal intraocular lens (IOL). Inclusive criteria were included visual complaints, photic henomena, or no improvement of vision-related quality of life (QOL) postoperatively.

Methods All complete ophthalmologic examinations, including visual function, biometry, refraction, ocular surface, IOL-related and vitreo-retinal assessments, reports of dysphotopsia with Glare and halos Questionnaire and vision-related QOL with NEI VFQ-25 were performed 1 month preoperatively and 3 months postoperatively. The main outcome measures were type of complaints, refractive state, posterior capsular opacity (PCO), reports of dysphotopsia, ocular co-morbidity, and patients’ vision-related QOL. Differences between both groups were compared using independent two- sample t test and Chi-square test.

Results A total of 564 patients were included. Blurred vision (with or without photic phenomenon) was reported in 160 cases (28%), including 75 cases in the multifocal group and 85 cases in monofocal group. Photic phenomena (with or without blurred vision) were reported in 109 cases (19.3%), including 66 cases in the multifocal group and 43 cases in monofocal group.

Results Both symptoms were present in 61 cases (10.8%), including 33 cases in the multifocal group and 28 cases in monofocal group. The 3 most significant causes of blurred vision or photic phenomena included dry eye syndrome (50~60%), posterior capsule opacification (PCO) (30~40%), and residual ametropia, especially astigmatism (25~30%) in the multifocal group and dry eye syndrome (30~45%), residual astigmatism (33~45%), and PCO (20~40%) in the monofocal group.

Results Compared with both IOL groups, the incidence of dry eye syndrome and PCO were significantly higher in the multifocal group than in the monofocal group. But the incidence of ametropia, including residual spherical equivalent and residual astigmatism, were significant higher in the monofocal group than in the multifocal group. Patients with PCO in both IOL groups were performed Nd-YAG capsulotomy (85%) and duration of capsulotomy after cataract surgery were no differences in both IOL groups.

Conclusion Patients received cataract extractions surgery, implanted multifocal or monofocal intraocular lens, with dissatisfied results can be classified by the main causes after the serial assessments and appropriate treatments could be given. Blurred vison or photic phenomena Refractive statusTear film functionSlit-lamp exam Dry eye syndrome Residual astigma PCO Artificial tear punctum plug Prescription IOL replacement Refractive surgery Nd-YAG laser capsulotomy