Multifocal versus Monofocal Intraocular Lens Implantation in Children with Cataracts.

PURPOSE To evaluate the efficacy and safety of multifocal versus monofocal intraocular lens (IOL) implantation in children with cataracts in a real-world setting. DESIGN Prospective, non-randomized comparative clinical study. METHODS Pediatric patients who underwent cataract surgery with multifocal IOL optic implantation in Berger space or monofocal IOL implantation with primary posterior capsulorhexis (PCCC) and anterior vitrectomy (AV) were recruited for this study. The efficacy outcome was postoperative visual acuity (corrected distance visual acuity (CDVA), distance-corrected intermediate visual acuity (DCIVA), and distance-corrected near visual acuity (DCNVA)), modulation transfer function (MTF), Strehl ratio (SR), ocular scatter index (OSI) and stereopsis. The safety outcomes were postoperative complications. RESULTS A total of 571 eyes of 402 children were included in our study. Multifocal IOLs were implanted in 219 children (311 eyes) and monofocal IOLs in 183 children (260 eyes). Visual results in bilateral or unilateral patients were better after multifocal IOL implantation than after monofocal IOL implantation, regardless of CDVA and DCNVA (P < 0.05). More patients developed postoperative Titmus stereopsis ≤100 arcseconds after multifocal IOL implantation compared to monofocal IOL implantation (both P < 0.05). The MTF and SR values showed a significant increase, and the OSI values showed a significant decrease after surgery (both P < 0.001). MTF cut-off, Strehl ratio, and OSI values showed no significant differences between unilateral and bilateral patients with multifocal or monofocal IOLs (P > 0.05). Multifocal IOL patients achieved higher spectacle independence than monofocal IOL patients (51.67% vs 37.31%, P = 0.033). IOL optic implantation in Berger space was achieved in 93.25% of the eyes with the multifocal IOL implantation (290/311). After surgery, the incidences of corneal edema, transient intraocular hypertension and visual axis opacification (VAO) of children after multifocal IOL implantation in Berger space were lower (2.28% vs. 9.84%, P = 0.017; 2.28% vs. 12.02%, P = 0.006; 0% vs. 6.56%, P = 0.014). CONCLUSIONS During the follow-up period of this study, multifocal intraocular lens optic implantation in Berger space demonstrated favorable safety and efficacy in improving visual function for rigorously screened pediatric cataract patients.