Preoperative corneal irregular astigmatism and long-term visual outcomes after multifocal intraocular lens implantation.

Abstract

Purpose: To investigate the clinical significance of preoperative higher-order aberrations in the long-term visual outcomes after multifocal intraocular lens (mIOL) implantation.

Setting: Keye Eye Center, Seoul, Korea.

Design: Retrospective single-center clinical cohort study.

Methods: Bilateral implantation of PanOptix mIOL with 3-year follow-up. Eyes were stratified based on total corneal irregular astigmatism (TCIA) in Scheimpflug tomography into low (≤0.15 μm), moderate (>0.15 to <0.30 μm), and high (≥0.30 μm) TCIA groups.

Results: In the cohort of 474 eyes of 237 patients, those with high TCIA had greater prevalence of prior refractive surgery (16% vs 2%; P < .001), greater spherical aberration (0.45 ± 0.26 diopters [D] vs 0.28 ± 0.10 D; P < .001), and lower central corneal thickness (511 ± 43 μm vs 548 ± 30 μm; P = .001) than those with low TCIA. High TCIA resulted in worse uncorrected distance visual acuity (UDVA) at 1 year (0.11 ± 0.10 vs 0.03 ± 0.08 logMAR units; P = .001) and at 3 years (0.16 ± 0.15 vs 0.04 ± 0.08 logMAR units; P < .001) compared with low TCIA, despite comparable postoperative refractive outcomes. At 3 years, Strehl ratio (0.024 ± 0.019 vs 0.041 ± 0.027; P = .001), photopic (1.23 ± 0.14 vs 1.39 ± 0.20; P < .001), and mesopic area under the log contrast sensitivity function (0.91 ± 0.16 vs 1.06 ± 0.19; P < .001) were worse in high TCIA group compared with low TCIA group. Greater preoperative TCIA was associated with poorer age-adjusted and sex-adjusted UDVA ( B = 0.174, 95% CI 0.101-0.248, P < .001), corrected distance visual acuity ( B = 0.261, 95% CI 0.132-0.389, P < .001), and Strehl ratio ( B = -0.598, 95% CI -0.865 to -0.332, P < .001) at 3 years.

Conclusions: High preoperative TCIA should be considered as predictive for impaired long-term visual acuity and quality outcomes after mIOL implantation.