Visual Outcome and Patient Satisfaction with Implantation of Trifocal Intraocular Lens After Radial Keratotomy

To investigate the visual outcomes and patient satisfaction following trifocal intraocular lens (IOL) implantation after radial keratotomy (RK).

This was a retrospective chart review wherein we studied 14 eyes from 7 patients who had undergone cataract surgery and had trifocal intraocular lens (IOL) implanted in the Eastern Province of Saudi Arabia's King Fahd University Hospital and Kahhal private centre. Data such as demographic characteristics, the time between RK and cataract removal, intraoperative and postoperative complications, preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and refraction were evaluated. In addition, visual complaints and satisfaction were assessed through a questionnaire.

All eyes included had 8 RK sections. The mean spherical equivalent was +1.81 ± 4.27 D preoperatively and was -0.41 ± 1.2 D at the last follow-up. The mean uncorrected distance visual acuity (UDVA) increased from 0.32 ± 0.2 prior to surgery to 0.64 ± 0.2 following surgery. The mean efficacy index was 1.01 and a safety index was 1.26. In the last follow-up, 29% reported having 0.5 spherical equivalents, while 86% were within 1D. Improvement in cylindrical correction was noticed in the last follow-up with 36% not more than 0.5 D and 43% within 1D. In total, 80% of patients had a distance-corrected near visual acuity (DCNVA) of better than 20/40. The survey response rate was 100%, and two patients reported a lower degree of satisfaction. Glare and difficulty seeing at night were the most often reported complaints, with a mean of 2.86 ± 1.95 and 22 ± 1.9, respectively.

Our results suggest that implantation of a trifocal IOL is safe and effective in patients with previous RK. However, several factors, including the patient's preoperative expectations, glare testing, refractive error, number of cuts, optical zone size, and visual phenomena related to RK, should be considered before implantation.