Ten-Year Outcomes of Refractive Lens Exchange With Trifocal Intraocular Lenses in Patients With Mild to Moderate...

To assess long-term visual outcomes and patient-reported satisfaction after refractive lens exchange (RLE) with trifocal intraocular lens (IOL) implantation in adults with mild to moderate amblyopia.

This cohort study evaluated 33 eyes of 31 patients with amblyopia in one or both eyes who underwent RLE with bilateral implantation of trifocal lenses. Implanted IOLs were AT LISA tri 839MP (Carl Zeiss Meditec AG) and FineVision Micro F (PhysIOL), including toric versions. Mean follow-up was 10 years. Outcome measures included uncorrected and corrected distance (UDVA and CDVA), intermediate, and near visual acuity, refraction, postoperative defocus curve, contrast sensitivity, stereopsis, and color perception. Patient-reported satisfaction was evaluated using two types of questionnaires.

In amblyopic eyes, mean spherical equivalent changed from 3.49 ± 3.07 diopters (D) before surgery to -0.18 ± 0.57 D at 10 years. Mean UDVA improved from 0.86 ± 0.32 logarithm of the minimum angle of resolution (logMAR) (Snellen 20/150) to 0.29 ± 0.15 logMAR (Snellen 20/40) postoperatively (P < .0001). Mean CDVA was 0.18 logMAR (Snellen 20/30) both preoperatively and postoperatively. Defocus curve corresponded to a trifocal profile. Contrast sensitivity was reduced in amblyopic eyes but remained within normal limits. Patient satisfaction with vision after surgery was high and stable throughout the follow-up.

In carefully selected patients with mild to moderate amblyopia, RLE with bilateral implantation of tri-focal IOLs substantially improved uncorrected visual acuity while maintaining the quality of visual function, accompanied by high long-term patient satisfaction. These findings support the viability of trifocal IOLs in a population historically excluded from multifocal refractive solutions.