Comparative analysis of the results of IOL implantation of full and extended partial range of vision in patients with a history of keratorefractive surgeries

Aim – to conduct a comparative retrospective analysis of the clinical outcomes of implantation of multifocal intraocular lenses (MIOLs) and intraocular lenses with extended depth of focus (EDOF) in patients with a history of refractive surgery. To evaluate the impact of the ocular surface condition on the quality of vision and patient satisfaction in the long term after phacoemulsification (PEC).

Material and methods. In a multicenter retrospective cohort study, data from 72 patients (101 eyes) aged 25 to 76 years were analyzed. After phacoemulsification, various models of intraocular lenses (IOLs) were implanted. The patients were divided into 2 groups: Group 1, patients with implanted full-range of vision IOLs - MIOLs (18 people, 26 eyes); Group 2, patients with implanted extended partial range of vision IOLs - EDOF (54 people, 75 eyes). All patients underwent a standard comprehensive ophthalmological examination. The work included a comparative analysis of uncorrected and corrected distance visual acuity (UCVA and CDVA), refraction data before phacoemulsification and 1 month after cataract surgery. In the late postoperative period, UCVA and CDVA were assessed at near (30 cm) and intermediate (45 cm) distances in both observation groups. The functional consequences of premium IOL implantation and subjective patient satisfaction were assessed using the individual Visual Function-14 (VF-14) quality of life questionnaire. Remote risk factors for the development and progression of dry eye syndrome (DES) were also recorded using the Schirmer 1 Test and the Norn test. Additionally, all subjects completed the Ocular Surface Disease Index (OSDI) questionnaire.

Results. The conducted analysis showed statistically significant change in visual acuity (VA) 1 month after surgery (p <0.001) in both observation groups. In Group 1, UCVA at distance after surgery was 0.70 (0.55–1.00), and CCVA was 0.80 (0.70–1.00). In Group 2, UCVA after surgery increased to 0.60 (0.45–0.85), CCVA 0.80 (0.70–1.00). At near distance (30 cm), UCVA and CCVA in patients with implanted full-range IOLs were 0.73±0.17 and 0.73±0.17, at intermediate distance, 0.40±0.17 and 0.47±0.17, respectively. In the second observation group, with implantation of the extended partial range of vision IOL, the UCVA and UCVA at near distance (30 cm) were 0.54±0.21 and 0.50±0.20, at medium distance (45 cm), 0.42±0.17 and 0.50±0.17, respectively. In both observation groups, a significant decrease in tear production and tear film stability (TS) was noted. The average values of the international OSDI questionnaire in all groups ranged from 21.53 to 22.38 points, which corresponds to normal values. According to the results of the VF-14 questionnaire, high subjective patient satisfaction was revealed, amounting to from 88.50 to 95.50 points.

Conclusions. The results of implantation of full-range IOLs and extended partial range IOLs showed comparable high clinical results of distance VA one month after FEC. However, at near distance, multifocal IOLs provided higher visual acuity, and at intermediate distance, on the contrary, extended partial range of vision. These types of premium high-tech pseudo-accommodating IOLs can provide high subjective satisfaction of patients with a history of keratorefractive surgeries, taking into account their individual needs in everyday life. This work confirms the need for an individual approach to each patient after previous keratorefractive surgery.