Clinical Outcomes after Bilateral Mix-and-Match Implantation of Extended Depth of Focus and Trifocal Intraocular Lenses

To evaluate the clinical outcomes after bilateral mix-and-match implantation of extended depth of focus (EDOF) and trifocal intraocular lenses (IOLs).

A total of 134 eyes of 67 patients who had met all inclusion and exclusion criteria and underwent bilateral cataract surgery were included. The Symfony or Symfony toric EDOF IOL (Johnson & Johnson Vision Care Inc.) was implanted in the dominant eye, and the PanOptix or PanOptix toric trifocal IOL (Alcon Laboratories Inc.) in the nondominant eye. The uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), defocus curve, contrast sensitivity, and satisfaction questionnaire were obtained preoperatively and at 1, 6, and 12 months after surgery.

At 12 months after surgery, the mean UDVA (logMAR) was 0.03 ± 0.06 in the EDOF IOL-implanted eyes, 0.07 ± 0.11 in the trifocal IOL-implanted eyes, and 0.02 ± 0.06 in both eyes. The mean UIVA was 0.08 ± 0.08 in EDOF IOL-implanted eyes, 0.09 ± 0.11 in trifocal IOL-implanted eyes, and 0.03 ± 0.08 in both eyes. Mean UNVA was 0.51 ± 0.26 in EDOF IOL-implanted eyes, 0.22 ± 0.16 in trifocal IOL-implanted eyes, and 0.17 ± 0.12 in both eyes. Overall satisfaction rates were 43.3%, 41.1%, and 38.5% at 1, 6, and 12 months, respectively, while more than 70% of patients consistently reported that they would recommend the surgery to others. The most common causes of dissatisfaction were dry eye symptoms and reduced near vision.

Bilateral mix-and-match implantation of EDOF and trifocal IOL implantation showed good visual outcomes for distance, intermediate, and near vision until 12 months. Most patients satisfied with visual quality, but more dissatisfied with dry eye disease and poor near vision than photopic phenomena like glare and halos.