Duet procedure allows for reversible trifocal IOL implantation
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VIENNA — The Duet procedure, in which a monofocal or monofocal toric IOL is implanted into the capsular bag and an additive trifocal IOL is implanted into the sulcus, showed stable long-term outcomes and good rotational stability.
“We do this to correct presbyopia but also to have an exit strategy for cases that may have a future loss of function — for example, in patients who may develop retinal detachment or glaucoma in the course of their lives,” Isabella D. Baur, MD, said at the European Society of Cataract and Refractive Surgeons meeting.
In these cases, if needed, it will be easier to explant a trifocal IOL from the ciliary sulcus, leaving an intact capsular bag with a monofocal or monofocal toric IOL in place.
A study included 34 eyes of 20 patients implanted with a monofocal toric IOL in the capsular bag and a Rayner Sulcoflex pseudophakic supplementary IOL in the sulcus. The mean follow-up was 24 months, ranging between 3 months and 47 months.
“It is important to notice that a lot of patients included in this study had an increased risk for deviation from target refraction because we usually do this procedure on patients who are not optimal cases,” Baur said.
However, the visual acuity results for distance, intermediate and near acuity were comparable to what could be expected from a capsular bag-fixated trifocal. Refractive cylinder was within less than 0.5 D of intended correction in 97% of the eyes, and 91% of the eyes were within 0.5 D of spherical equivalent target refraction.
Mean deviation from the calculated cylinder axis was 3.8°, and 94% of all eyes showed a rotation of less than 10°.
“Rotational stability is of particular interest because repositioning the toric IOL after implanting the trifocal IOL is more challenging with the Sulcoflex in front of the toric IOL in the bag,” Baur said.
Only two eyes had a deviation larger than 10°, and the maximum deviation was 15°.
“For those two cases we evaluated intervention, but as both eyes had good uncorrected visual acuity, we decided not to intervene,” Baur said.
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Baur ID, et al. Long-term functional results and rotational stability of capsular bag-fixated toric intraocular lenses in Duet procedure. Presented at: European Society of Cataract and Refractive Surgeons meeting; Sept. 8-12, 2023; Vienna.
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