Clinical and Self-Reported Outcomes after Multifocal Intraocular Lens Implantation of Patients with Stable Keratoconus

Abstract

Background: Multifocal intraocular lens (IOL) implantation is generally not considered in patients with keratoconus; however, it may provide good optical results in selected patients with stage I and II keratoconus based on two case reports. Aims: To evaluate patient satisfaction and clinical outcomes in this patient population.Methods: This is a retrospective single-center, non-interventional, non-comparison study. All patients with frank keratoconus who had undergone a trifocal IOL implantation between 2016 and 2019 were invited to participate in this study (18 eyes of 9 patients). Postoperatively, refractive outcomes, contrast sensitivity, and ocular aberrations were recorded. A questionnaire was used for determining patient satisfaction and their quality of life. The mean follow-up time was 31.22 ± 6.38 months.Results: Postoperatively the patients’ uncorrected distance visual acuity improved from 1.13 ± 0.93 to 0.10 ± 0.17 (p˂0.001), corrected distance visual acuity went from 0.10 ± 0.11 to 0.05 ± 0.09 (p=0.19), mean refractive spherical equivalent changed from -4.34 ± 4.31 to 0.05 ± 0.51 D (p˂0.001), and manifest astigmatism from 2.44 ± 1.92 to 0.88 ± 1.81 D (p=0.017). A target refraction of less than ± 0.50 D was achieved in 17 eyes (94%) and one eye exhibited a hyperopic MRSE of +2.0 D. Three eyes (17%) lost 1 line of best corrected visual acuity and no patient lost two or more lines. The patients were independent of glasses in 78% for all distances. Conclusions: A trifocal IOL currently gives relatively good, predictable results with most patients feeling satisfied with the results of spectacle independence for all distances.