Clinical outcomes of enhanced monofocal intraocular lens implantation in phacovitrectomy according to epiretinal membrane severity

Abstract

Purpose : To compare the visual outcomes and qualities of implantation of a monofocal intraocular lens (IOL) with enhanced intermediate function and a conventional monofocal IOL in phacovitrectomy according to epiretinal membrane severity.

Methods : Medical records of 82 eyes from 82 patients who underwent combined cataract-vetireoretinal surgery were retrospectively analyzed. Patients received either conventional (Tecnis PCB00; n=34) or enhanced (Tecnis Eyhance; n=48) monofocal IOL. We classified the ERM into four stages (2.4%, 45.1%, 34.1%, and 18.3%, respectively) based on inner retina changes. The photoreceptor (PR) status was categorized into intact PR (45.1%), cone outer segment termination (COST) disruption (36.6%), and ellipsoid zone (EZ) disruption (29.3%) group. Pre- and postoperative uncorrected (UDVA) and corrected (CDVA) distance visual acuities were measured. Uncorrected intermediate (UIVA) and near (UNVA) visual acuities, contrast sensitivity, and defocus curve were evaluated postoperatively.

Results : Distribution based on stage and PR status was not different between PCB00 and Eyahnce group. From stage 1 to 3, Eyhance IOL showed superior UIVA and UNVA, and equivalent UDVA compared with PCB00. However, patients with stage 4 ERM showed no difference of UIVA and UNVA between two IOLs. Intact PR and COST disruption group showed better UIVA and UNVA with Eyhance, but EZ disruption group did not. On defocus curve, stage 4 and EZ disruption group failed to demonstrate better outcomes of Eyhance on intermediate range. Overall, there was no significant difference in contrast sensitivity between two IOLs.

Conclusions : Selective use of extended monofocal IOL based on ERM staging and PR status is necessary. Specifically, it should be avoided in eyes with stage 4 or EZ disrupted ERM during phacovitrectomy.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.