[Comparison of the influence of decentration and tilt of two types of trifocal intraocular lenses on objective visual quality].

Abstract

Objective: To compare the differences in decentration and tilt between two types of trifocal intraocular lenses (IOL) and their impacts on postoperative objective visual quality. Methods: This was a prospective cohort study. One eye was consecutively enrolled from each cataract patient who underwent bilateral phacoemulsification cataract extraction combined with IOL implantation at Peking University Third Hospital between January 2023 and June 2024. Patients were divided into two groups based on the type of implanted IOL: the 839MP group (AT LISA tri 839MP IOL) and the Panoptix group (AcrySof IQ PanOptix IOL). At 3 months postoperatively, the following parameters were compared between the two groups: uncorrected distance, intermediate (80 and 60 cm), and near visual acuities; best-corrected distance visual acuity; spherical equivalent refraction; IOL decentration distance and tilt angle. Additionally, total higher-order aberrations (HOAs), coma, trefoil, spherical aberration of the whole eye and intraocular, and modulation transfer function (MTF) were measured, and the severity of adverse visual phenomena was graded. Pearson correlation analysis was used to explore the correlation between IOL decentration/tilt and total HOAs of the whole eye. Receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off values of IOL decentration and tilt for predicting total HOAs of the whole eye >0.3 μm and >0.5 μm, with the area under the curve (AUC) used to evaluate predictive efficacy. Results: Forty-five patients (45 eyes) were recruited in each group, and 42 patients (42 eyes) in each group completed the follow-up, with a total of 84 patients (84 eyes). Among them, there were 28 males and 56 females, with a mean age of 65 years. No statistically significant differences were observed between the two groups in terms of gender, age, eye laterality, axial length category, IOL power, preoperative lens decentration and tilt, Kappa angle, or Alpha angle (all P>0.05). At 3 months postoperatively, there were no significant differences between the 839MP and Panoptix groups in uncorrected distance, intermediate (80 cm), and near visual acuities or best-corrected distance visual acuity (all P>0.05). However, for uncorrected intermediate visual acuity at 60 cm, the Panoptix group performed better than the 839MP group (P<0.001). Regarding IOL decentration, the total decentration distance and vertical decentration distance in the 839MP group were (0.27±0.16) mm and (0.17±0.11) mm, respectively, which were significantly lower than those in the Panoptix group [(0.44±0.26) mm and (0.35±0.28) mm, respectively; all P<0.05]. For IOL tilt, no significant difference was found in the total tilt angle between the 839MP group (3.83°±2.15°) and the Panoptix group (3.08°±1.70°) (P>0.05). In terms of objective visual quality, the total HOAs of the whole eye, ocular HOAs, and total intraocular HOAs in the 839MP group were (0.222±0.094) μm, (0.099±0.071) μm, and (0.195±0.094) μm, respectively, which were significantly lower than those in the Panoptix group [(0.324±0.243) μm, (0.168±0.166) μm, and (0.304±0.240) μm, respectively; all P<0.05]. No correlation was observed between IOL tilt/decentration and intraocular HOAs in either group (P>0.05). ROC curve analysis showed that for evaluating IOL tolerance to decentration and tilt: when total HOAs of the whole eye>0.3 μm, the cut-off values of IOL decentration and tilt were 0.29 mm (AUC=0.69) and 5.1° (AUC=0.79) in the 839MP group, and 0.33 mm (AUC=0.76) and 3.2° (AUC=0.81) in the Panoptix group; when total HOAs of the whole eye>0.5 μm, the cut-off values of IOL decentration and tilt were 0.54 mm (AUC=0.64) and 6.9° (AUC=0.85) in the 839MP group, and 0.61 mm (AUC=0.72) and 4.7° (AUC=0.88) in the Panoptix group. No significant difference was noted in the incidence of adverse visual phenomena between the two groups (all P>0.05). Conclusions: In the early postoperative period after trifocal IOL implantation, compared with the Panoptix IOL, the 839MP IOL exhibits smaller decentration and better objective visual quality. Furthermore, at the same tilt level, the 839MP IOL provides better objective visual quality; whereas at the same decentration level, the Panoptix IOL shows superior objective visual quality.