Bilateral Refractive Lens Exchange With Trifocal Intraocular Lens for Hyperopia in Patients Younger Than 40 Years: A Case–Control Study

Abstract

PURPOSE: To evaluate visual outcomes, satisfaction, and spectacle independence in non-presbyopic hyperopic patients who underwent bilateral refractive lens exchange with a trifocal intraocular lens (IOL) and to compare them with presbyopic hyperopic patients. METHODS: In this retrospective study, patients younger than 40 years underwent bilateral refractive lens exchange with a diffractive trifocal IOL (FineVision Micro F; PhysIOL SA) for hyperopia with at least 3 months of follow-up. A control group of patients older than 50 years was matched by axial length, sex, and follow-up. Safety, efficacy, predictability, patient satisfaction, and spectacle independence were evaluated. RESULTS: One hundred thirty-three patients (average age = 36.94 ± 2.91 years; range = 21.50 to 40 years) were included in this study. After a mean follow-up of 8.83 ± 5.69 months (range = 2.75 to 77.63 months), the safety and efficacy indexes and predictability within ±1.00 diopters (D) were 1.02%, 0.98%, and 99.62%, respectively, which was not different from the control group ( P > .05). No intraoperative complications were recorded. The only postoperative complication was posterior capsule opacification in 21 eyes (7.89%), which was similar to the control group ( P > .05). Ninety-seven percent of patients in each group expressed that they were satisfied and all of them in each group reported that they did not use spectacles for distance, intermediate, or near vision. CONCLUSIONS: Refractive lens exchange and trifocal IOL implantation for hyperopia in patients without presbyopia provided the same good visual outcomes as in presbyopic patients with a high rate of patient satisfaction and spectacle independence. [ J Refract Surg . 2021;37(8):524–531.]

Effectiveness of SMILE Combined with Micro-Monovision in Presbyopic Patients: A Pilot Study

“…An alternative to micro-monovision with SMILE can be the refractive lens exchange (RLE), which consists of replacing the clear crystalline lens by a multifocal intraocular lens [ 27 ]. Poorer results have been reported for RLE in young hyperopic patients (<40 years old) in comparison to our study for UDVA (0.01 logMAR), UIVA (0.2 logMAR), and UNVA (0.07 logMAR) [ 28 ]. On the other hand, binocular CSDC might result in reduced CS with multifocal IOLs [ 13 ], especially in the near and intermediate ranges, even though this has not been reported in young presbyopic patients as in our study.…”

Visual Outcomes and Patient Satisfaction After Bilateral Refractive Lens Exchange with a Trifocal Intraocular Lens in Patients with Presbyopia

“…Trifocal IOLs have been available in the global market since 2010. The AT Lisa and FineVision IOL are not available in the USA but have similarly been implanted with good refractive outcomes and patient satisfaction in non-presbyopes and presbyopic hyperopes and emmetropes abroad [ 30 , 31 ]. These studies further highlight the utility of trifocal IOLs in addressing the needs of patients without cataract.…”

FS-LASIK for the treatment of moderate-to-high hyperopia

“…1 However, despite this study and the appearance of similar studies, LASIK remained unpopular among refractive surgeons and it is generally avoided for hyperopias over +3.5/4 D, where RLE is being increasingly performed even for young patients without presbyopia. 2,3,[5][6][7] In this scenario, we wanted to look into this again, taking a new sample of patients with those degrees of hyperopia that usually are rejected for LASIK (over +3.5/4 D) but where the capability of LASIK to treat such refractive defects is proven, with good levels of efficacy and safety. Thus, removing those outliers of patients with very high hyperopia (up to +8 D) could be biasing the results in all previous literature.…”