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Introduction <p>To compare the benefits of secondary trifocal intraocular lens (IOL) implantations versus one-step IOL implantations in managing dense cataracts.</p> Methods <p>Patients with dense cataracts, a preoperative axis length (AL) of 21.00–27.00&#xa0;mm, and corneal astigmatism ≤ 1.00 D were enrolled at Wuhan Aier Hankou Eye Hospital. Patients unsuitable for femtosecond laser-assisted cataract surgeries (FLACS) were excluded. Patients who underwent one-step monofocal IOL implantations were involved in group A, and those who accepted two-step trifocal IOL implantations entered group B. Pre- and postoperative AL, corneal keratometry (<i>K</i>) value, visual acuity, and endothelial cell density (ECD) were measured. Postoperative spherical equivalent (SE), numerical error (NE), and mean absolute error (MAE) were calculated.</p> Results <p>Applying the inclusion/exclusion criteria, 42 eyes were finally included in group A, and 32 eyes were involved in group B. In group B, six eyes (15.79%) were identified as unsuitable for multifocal IOL (MIOL) implantation because of fundus diseases. Patients in group B achieved a greater proportion of SE and NE closer to 0 D. The postoperative MAE of group B was also obviously lower than that of group A. Uncorrected distant visual acuity (UDVA) of patients in group B was superior to that in group A during the 90-day postoperative follow-up period. Postoperative AL, surgically induced astigmatism (SIA), and ECD loss did not show significant differences between the two groups.</p> Conclusions <p>Compared to one-step IOL implantation, the two-step approach allowed more accurate IOL power calculation, reduced refractive error, and better UDVA; did not increase SIA or ECD loss; and allowed for fundus disease screening, making it a good choice in dense cataracts for MIOL implantations.</p> Trial registration <p>This trial was registered with the Chinese Clinical Trial Registry (<a href="http://www.chictr.org.cn/">http://www.chictr.org.cn/</a>). Trial registration number: ChiCTR2100043570.</p>

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Secondary Trifocal Intraocular Lens Implantation in Dense Cataracts: A Promising Alternative to One-Step Surgery

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月20日

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  • Jingyu Qu,
  • Wei Xiao,
  • Yue Wang,
  • Ya Jiao,
  • Shiqi Dong,
  • Rong Xu

摘要

Introduction

To compare the benefits of secondary trifocal intraocular lens (IOL) implantations versus one-step IOL implantations in managing dense cataracts.

Methods

Patients with dense cataracts, a preoperative axis length (AL) of 21.00–27.00 mm, and corneal astigmatism ≤ 1.00 D were enrolled at Wuhan Aier Hankou Eye Hospital. Patients unsuitable for femtosecond laser-assisted cataract surgeries (FLACS) were excluded. Patients who underwent one-step monofocal IOL implantations were involved in group A, and those who accepted two-step trifocal IOL implantations entered group B. Pre- and postoperative AL, corneal keratometry (K) value, visual acuity, and endothelial cell density (ECD) were measured. Postoperative spherical equivalent (SE), numerical error (NE), and mean absolute error (MAE) were calculated.

Results

Applying the inclusion/exclusion criteria, 42 eyes were finally included in group A, and 32 eyes were involved in group B. In group B, six eyes (15.79%) were identified as unsuitable for multifocal IOL (MIOL) implantation because of fundus diseases. Patients in group B achieved a greater proportion of SE and NE closer to 0 D. The postoperative MAE of group B was also obviously lower than that of group A. Uncorrected distant visual acuity (UDVA) of patients in group B was superior to that in group A during the 90-day postoperative follow-up period. Postoperative AL, surgically induced astigmatism (SIA), and ECD loss did not show significant differences between the two groups.

Conclusions

Compared to one-step IOL implantation, the two-step approach allowed more accurate IOL power calculation, reduced refractive error, and better UDVA; did not increase SIA or ECD loss; and allowed for fundus disease screening, making it a good choice in dense cataracts for MIOL implantations.

Trial registration

This trial was registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn/). Trial registration number: ChiCTR2100043570.