June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Comparative analysis of efficacy between trifocal and bifocal diffractive intraocular lens implantation after cataract surgery or refractive lens exchange: a meta-analysis of randomized controlled trials
Author Affiliations & Notes
  • Chang Ho Yoon
    Ophthalmology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
    Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea (the Republic of)
  • In Soo Shin
    Education, College of Education, Jeonju University, Jeonju, Korea (the Republic of)
  • Mee Kum Kim
    Ophthalmology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
    Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea (the Republic of)
  • Won Ryang Wee
    Ophthalmology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
    Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea (the Republic of)
  • Footnotes
    Commercial Relationships   Chang Ho Yoon, None; In Soo Shin, None; Mee Kum Kim, None; Won Ryang Wee, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 1142. doi:
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      Chang Ho Yoon, In Soo Shin, Mee Kum Kim, Won Ryang Wee; Comparative analysis of efficacy between trifocal and bifocal diffractive intraocular lens implantation after cataract surgery or refractive lens exchange: a meta-analysis of randomized controlled trials. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1142.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To compare the efficacy between trifocal and bifocal diffractive intraocular lens (IOL) implantation in presbyopic patients who underwent cataract surgery or refractive lens exchange

Methods : Through Pubmed, Medline, Embase, and Cochrane Controlled Trials Register, we searched potentially relevant articles published from 1990 to 2016. Distance, intermediate, and near visual acuities (VAs) and defocus curves were measured as primary outcomes. Spectacle dependence, postoperative refraction, higher-order aberrations (HOAs), and contrast sensitivity (CS) were measured as secondary outcomes. Effects were pooled using random-effects method. Relative risk (RR), mean difference (MD), and 95% confidence intervals (CI) were used to compare the parameters.

Results : Among the 124 studies, 5 randomized controlled trials were selected, with a total of 260 eyes of 130 subjects. The trifocal IOL showed better monocular uncorrected distance VA than the bifocal IOL (MD, -0.03 logMAR; 95% CI, -0.06 to 0.00; P=.03). The proportion of patients who did not achieve binocular uncorrected intermediate VA of 0.1 logMAR was lower in the trifocal IOL (7.7%) than in the bifocal IOL (43.5%) (RR, 0.18; 95% CI, 0.04 to 0.75; P=.02; Fig. 1). The trifocal IOL showed better binocular distance VA corrected with defocus levels of -1.0, -1.5, and -2.5 diopter (D) than the bifocal IOL (All P≤.001; Fig. 2). No significant differences were found between the two groups in monocular uncorrected intermediate and near VAs; monocular corrected distance, intermediate, and near VAs; and binocular distance, intermediate, and near VAs. Spectacle dependence was lower in the trifocal IOL (10.0%) than in the bifocal IOL (29.2%) with marginal significance (RR, 0.38; 95% CI, 0.13-1.13; P=.08). Refractive cylinder was higher in the bifocal IOL than in the trifocal IOL (MD, 0.18 D; 95% CI, 0.07 to 0.28; P=.001). Spherical equivalent, CS, and HOAs were not significantly different from each other.

Conclusions : The overall findings indicate that both bifocal and trifocal IOLs provide comparable distance and near VAs. Trifocal IOL implantation may provide better intermediate VA and greater spectacle independence.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

Fig. 1 Forest plot of the number of patients who did not achieve 0.1 logMAR

Fig. 1 Forest plot of the number of patients who did not achieve 0.1 logMAR

 

Fig. 2 Forest plot of binocular distance corrected defocus curves

Fig. 2 Forest plot of binocular distance corrected defocus curves

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