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Trifocal IOL shows good vision at all distances at 1 year
The lens allows complete spectacle independence, but problems remain with posterior capsule opacification, study finds.
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One year of follow-up with the At Lisa tri 839MP IOL showed that vision at all distances was maintained, allowing complete spectacle independence.
“Only [posterior capsule opacification] formation decreased the performance of the lens in some patients, as it may be expected with multifocal optics,” David P. Piñero, PhD, said in an interview with Ocular Surgery News.
A study was published on a consecutive series of 120 eyes of 60 cataract patients, operated on by one surgeon and implanted with the lens.
“To our knowledge, this is the first study evaluating a trifocal lens over 12 months. We are continuing to monitor these patients but don’t expect surprises. Results are maintained during this second year,” Piñero said.
Complete visual rehabilitation was obtained with the lens at all distances, including intermediate, as shown by the smooth defocus curves. The level of aberrations induced by the lens was minimal, within the physiological level, and contrast sensitivity was excellent, Piñero said.
Peter Mojzis, MD, PhD, FEBO, is the surgeon who implanted the At Lisa tri (Carl Zeiss Meditec) in the study.
“The At Lisa tri is becoming very popular now in the Czech Republic and is currently adopted by the majority of centers that perform premium procedures,” Mojzis said. “It is now my favorite IOL, my first choice with patients who are motivated to achieve spectacle independence.”
The lens is preloaded in a dedicated injector, which allows surgery through small 1.6- to 1.8-mm incisions. The advantages of the preloaded system are ease of insertion, minimal induction of inflammation, and no contact between the surgeon and the lens.
The plate haptic design grants stability, and the 6-mm aspheric optic is designed to be independent from the pupil size. Another important asset is that the addition is 1.66 D at intermediate and 3.33 D at near. The lens consists of two parts, a central trifocal optic over 4.34 mm and a peripheral bifocal zone between 4.34 mm and 6 mm. It is made of hydrophilic acrylic material with a hydrophobic surface and square edges for PCO prevention.
PCO main issue with lens
The same study evaluated PCO in the central 4.34-mm zone, which is important for vision and patient satisfaction. PCO occurred in 19 eyes (15.8%), and the mean 12-month PCO score measured with the EPCO 2000 software was 0.320.
“It was the proliferative form of PCO in the majority of cases, which is very easy to remove,” Mojzis said. “In these patients I performed surgical irrigation/aspiration, dislocated the IOL in the anterior chamber, aspirated the Elschnig pearls and repositioned the IOL in the capsular bag. This was in 15 eyes, while in four eyes we found fibrosis, not a lot but enough to affect visual acuity and to require YAG capsulotomy,” Mojzis said.
PCO resulted in minimal but statistically significant changes in visual outcomes over the 12 months of the study, Piñero said. A worsening logMAR visual acuity of half a line or less was observed at all distances and was consistent with a small but statistically significant increase in the level of ocular and internal higher-order aberrations, without specific changes in the level of primary coma.
In the 3 to 5 months after the study, the PCO rate increased to about 30%.
“We don’t know why, but PCO rate is always higher with multifocal lenses. It is also the main drawback of all multifocal lenses. However, this complication is very easy to manage,” Mojzis said.
YAG is the least problem because it is a routine procedure with guaranteed success. “Indication of vitreous opacity is a potential unwanted effect. I had to perform vitrectomy in one patient, and after vitrectomy satisfaction was complete,” he said.
Every multifocal lens, Mojzis said, has its own problems, advantages and disadvantages.
“ReSTOR IOLs (Alcon) have had problems with glistening, which is much worse because you have to explant the lens. With the Oculentis IOLs, the problem is rotation, which is tough with a segmental optic that has to be repositioned. Another trifocal lens, the FineVision (PhysIOL) is a very good lens, but the first model had problems with tilt because of the unstable haptics,” he said.
There are also two new trifocal lenses with a third focus on intermediate distance, the PanOptix (Alcon) and the Alsafit trifocal VF (Alsanza), he said.
Transient photic phenomena
The occurrence of photic phenomena was evaluated thorough a validated questionnaire, Piñero said. Glare and halos were reported in the immediate postoperative period but reduced significantly during the follow-up and were no longer an issue at 12 months.
“Patients should know that they might experience this sort of problem in the early postoperative period. They should know that it is normal and that it is going to end. If they have this information, they are less affected and don’t perceive it as a problem. On the other hand, contrast sensitivity is good from the beginning, and this is what matters most,” he said.
The study on the At Lisa tri is ongoing. Mojzis’ series has now achieved almost 300 cases, and data will be evaluated in the near future.
“We certainly need a longer follow-up and more patients, but definitely this IOL is an excellent option for presbyopia, an option that should be considered by all cataract surgeons,” Piñero said. – by Michela Cimberle
- Reference:
- Mojzis P, et al. J Cataract Refract Surg. 2015;doi:10.1016/j.jcrs.2014.11.050.
- For more information:
- Peter Mojzis, MD, PhD, FEBO, is medical director at Premium Clinic Teplice and Chief of the Eye Department, Regional Hospital in Havlickuv Brod, Czech Republic. He can be reached at email: mojzispeter@hotmail.com.
- David P. Piñero, PhD, is an assistant professor at the Department of Optics, Pharmacology and Anatomy, University of Alicante, Spain, and scientific collaborator at Premium Clinic, Teplice, Czech Republic. He can be reached at email: david.pinyero@gcloud.ua.es.
Disclosures: Mojzis reports he is a speaker and consultant for Carl Zeiss Meditec. Piñero reports no relevant financial disclosures.