Contrast Sensitivity After Combined MIGS and Cataract Surgery: A Comparison of Monofocal and Enhanced Monofocal...

Background/Objectives: Contrast sensitivity (CS) is an important measure of visual function, particularly in patients with glaucoma. While minimally invasive glaucoma surgery (MIGS) combined with cataract surgery is increasingly performed, postoperative CS outcomes-especially comparing enhanced monofocal intraocular lenses (emIOLs) and monofocal intraocular lenses (mIOLs)-remain unclear. This study aimed to compare postoperative CS between emIOL and mIOL in eyes undergoing combined MIGS and cataract surgery. Methods: This retrospective observational study included eyes that underwent combined MIGS and cataract surgery at a single center. CS was measured preoperatively and at 2-3 months postoperatively using the imo vifa system and quantified as the area under the log contrast sensitivity function (AULCSF). Clinical parameters were compared between IOL types using univariate and multivariate analyses, including a generalized linear mixed model (GLMM). Propensity score matching was performed to adjust for baseline differences. Results: A total of 140 eyes (71 emIOL, 69 mIOL) were analyzed. CS significantly improved postoperatively in both groups (p < 0.001). In multivariate analysis, IOL type was not significantly associated with CS (p = 0.10), whereas postoperative status was associated with improved CS (p = 0.01). CS measurement pattern significantly affected results, but no interaction between IOL type and measurement pattern was observed. After propensity score matching, postoperative CS was higher in the emIOL group (p = 0.01); however, multivariate analysis still showed no significant association between IOL type and CS (p = 0.20). Conclusions: CS improved after combined MIGS and cataract surgery regardless of IOL type. No independent difference in CS was observed between emIOL and mIOL, suggesting that emIOL may provide comparable visual quality in terms of CS, even in glaucoma patients.