Refractive lens exchange with the diffractive multifocal Tecnis ZM900 intraocular lens

To assess visual outcomes and patient satisfaction after refractive lens exchange followed by bilateral implantation of the multifocal Tecnis intraocular lens (IOL).

This prospective case series involved 59 eyes of 30 patients aged 56 +/- 8 years. Fifty-seven eyes were hyperopic (+3.52 +/- 1.80 diopters [D]) and 2 eyes were myopic (-1.12 +/- 0.53 D). Near, intermediate, and distance visual acuities were assessed at 1 and 6 months postoperatively. At last follow-up, patients were asked about their overall satisfaction, the occurrence of photic phenomena, difficulties driving at night, and spectacle independence.

Six months after surgery and laser retreatment in 15 eyes, 90% of eyes achieved monocular uncorrected distance visual acuity of 20/30 or better (0.087 +/- 0.085 logMAR) and 100% of eyes could read J2 or better without correction, including 90% of eyes achieving J1 or better (0.133 +/- 0.095 logMAR). Evaluation of visual performance at 1 month versus 6 months (n = 44 eyes, no retreatment) revealed a considerable improvement of the uncorrected (0.175 +/- 0.122 vs 0.127 +/- 0.094 logMAR; P = .005) and distance-corrected (0.099 +/- 0.057 vs 0.068 +/- 0.031 logMAR; P = .001) near visual acuity whereas mean refractive errors and distance visual acuity remained unchanged. Overall, 96.4% of patients were very satisfied with the procedure and would choose the same lens again. The majority of patients (92.8%) were totally free from spectacles with only 7.2% occasionally wearing glasses for intermediate tasks.

The multifocal Tecnis ZM900 IOL provides good distance and near vision after refractive lens exchange and a period of neuroadaptation. However, laser vision correction might be required to achieve emmetropia as well as spectacles to achieve good intermediate vision.