Performance of Trifocal Intraocular Lens Implantation in Highly Myopic Patients With and Without Astigmatism

To analyze the performance of trifocal intraocular lens (IOL) implantation in patients with high myopia vs patients with low-to-moderate myopia, with or without astigmatism.

A retrospective study examining trifocal IOL implantation in myopic patients was conducted at a single institution by one surgeon. Patients were followed on postoperative day 1, at one month, and at three months. Refraction was performed between the first and third months. A previously validated 10-question survey, scored from 0-10, was conducted one month after surgery. Patients were grouped into high myopia (≤ -5.00 diopters (D), axial length >25 mm) and low-to-moderate myopia (-1.00 to -5.00 D, axial length <25 mm). Exclusion criteria included high spherical aberration above 0.6, macular pathology, glaucoma, corneal disease, or scarring. Refractive outcomes, uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), and patient satisfaction surveys were compared.

A total of 72 eyes were included in the study (26 high myopes and 46 low-to-moderate myopes). The axial length and sphere were 26.67 ± 1.44 mm and -7.29 ± 2.80 D in the high myopia group vs 24.10 ± 1.11 mm and -2.38 ± 1.86 D in the low-to-moderate myopia group, p<0.001 and p<0.001, respectively. At one month postoperatively, UDVA, UNVA, and spherical equivalent (SE) revealed no difference between myopic groups. Residual refractive errors were ≤0.5 D in >90% of high (n=46) and low-to-moderate myopes (n=26). Comparing patients with >1.0 D of astigmatism in both high myopic (n=14) and low-to-moderate myopic groups (n=24) revealed no significant difference in sphere, cylinder, SE, monocular and binocular UDVA or UNVA, p>0.05. Overall patient satisfaction and the presence and severity of dysphotopsias were also similar between all groups, p>0.05.

Trifocal IOL may demonstrate high levels of visual performance and patient satisfaction in the presence of high axial myopia vs low-to-moderate myopia in patients with greater or less than 1.0 D of astigmatism in specific patients.