Preoperative Corneal Irregular Astigmatism and Long-Term Visual Outcomes After Multifocal Intraocular Lens Implantation.
TL;DR
High preoperative TCIA should be considered as predictive for impaired long-term visual acuity and quality outcomes after MIOL implantation, despite comparable postoperative refractive outcomes.
Abstract
Purpose
Multifocal intraocular lenses (MIOLs) are disadvised among patients with irregular corneas, but the role of subclinical corneal irregular astigmatism on long-term visual outcomes remains poorly elucidated.
Setting
Keye Eye Center, Seoul, Korea.
Design
Retrospective single-center clinical cohort study.
Methods
Bilateral implantation of PanOptix MIOL with 3 years follow-up. Eyes were stratified based on total corneal irregular astigmatism (TCIA) in Scheimpflug tomography into low (≤0.15 µm), moderate (>0.15 to <0.30 µm), and high (≥0.30 µm) TCIA groups.
Results
In the cohort of 474 eyes of 237 patients, those with high TCIA had greater prevalence of prior refractive surgery (16% vs 2%; p<0.001), greater spherical aberration (0.45±0.26D vs 0.28±0.10D; p<0.001), and lower central corneal thickness (511±43µm vs 548±30µm; p=0.001) than those with low TCIA. High TCIA resulted in worse uncorrected distance visual acuity (UDVA) at 1-year (0.11±0.10 vs 0.03±0.08 logMAR units; p=0.001) and at 3-years (0.16±0.15 vs 0.04±0.08 logMAR units; p<0.001) compared to low TCIA, despite comparable postoperative refractive outcomes. At 3-years, Strehl ratio (0.024±0.019 vs 0.041±0.027; p=0.001), photopic (1.23±0.14 vs 1.39±0.20; p<0.001) and mesopic AULCSF (0.91±0.16 vs 1.06±0.19; p<0.001) were worse in high TCIA group compared to low TCIA group. Greater preoperative TCIA was associated with poorer age- and sex-adjusted UDVA (B=0.174, 95%CI: 0.101 to 0.248, p<0.001), corrected distance visual acuity (B=0.261, 95%CI: 0.132 to 0.389, p<0.001), and Strehl ratio (B=-0.598, 95%CI: -0.865 to -0.332, p<0.001) at 3-years.
Conclusions
High preoperative TCIA should be considered as predictive for impaired long-term visual acuity and quality outcomes after MIOL implantation.