Multifocal and EDOF IOL – combined implantation options

Rationale: EDOF IOLs, while providing an extended depth of focus, are associated with fewer adverse optical phenomena, although they may limit near vision. Therefore, to expand visual capabilities, methods of mini-monovision and combined IOL implantation are used. Objective: To analyze the effectiveness of combined implantation of a non-diffractive EDOF IOL and a multifocal intraocular lens. Materials and Methods: This prospective study included 138 patients (276 eyes), comprising 77 women and 61 men, after bilateral or unilateral implantation of various IOL models. Group I included 40 patients (80 eyes) after combined implantation of the AcrySof IQ Vivity IOL (n = 40) in the dominant eye and the AcrySof IQ Panoptix IOL (n = 40) (Alcon, USA) in the non-dominant eye, with a mean follow-up period of 15.4±1.2 (range 12-22) months. Group II included 40 patients (80 eyes) who underwent bilateral implantation of the EDOF AcrySof IQ Vivity IOL. Group III consisted of 58 patients (116 eyes) with bilateral implantation of the trifocal AcrySof PanOptix IOL. All patients underwent a comprehensive standard and special ophthalmological examination. Phacoemulsification cataract surgery was performed using a standard technique. Results: A significant (p<0.05) increase in UDVA, CDVA, and UNVA was observed at the maximum follow-up period compared to preoperative values in all groups. In Group III and Group I (combined implantation), a significantly greater increase in UDVA and CDVA was noted at the 3-month follow-up compared to Group II (up to 0.83±0.14; p<0.05 and 0.82±0.09 (p = 0.048), respectively) with distance correction throughout the entire follow-up period (p<0.05). Patients in Group II were characterized by an increase in UNVA from 0.29±0.09 preoperatively to 0.9±0.20 at the maximum follow-up period. A similar dynamic was noted in Group III (0.34±0.09 and 0.87±0.13, respectively). Over the same follow-up period, an increase in UNVA was observed in Group I from 0.31±0.06 to 0.86±0.14, respectively. The differences between the groups at all follow-up periods were not statistically significant (p-0.05). In the combined implantation group, a reduction in the spherical equivalent of refraction was shown from -2.50±1.3 to -0.12±0.64 at the 3-month follow-up. In Group II, 10% of patients reported complaints of ‘glare’, 10% of ‘halos’, and there were no complaints of difficulties with night driving. In Group III patients, the frequency of unwanted optical phenomena was significantly higher: 32.8% of patients complained of glare, 27.6% of halos, and 24.1% of patients reported difficulties with night driving. In Group I (combined implantation), the frequency of complaints was comparable to Group II: glare (10%), halos (10%), and difficulties with driving at dusk (5%). Conclusion: Combined implantation of EDOF and trifocal IOLs demonstrated advantages compared to bilateral implantation of each of these lens types: it allows for achieving higher near visual acuity while simultaneously reducing the frequency of adverse optical phenomena.