Hydrophobic Acrylic Trifocal IOL in Post–Laser Refractive Surgery Eyes: Visual Performance, Predictability, and Patient‐Reported Outcomes
Yong Hyu Goh, Yoon Seong Choi, Sungho Choi, Dong Hui Lim, Sung Jin Na, Deok Jo NamPurpose
To evaluate clinical and patient‐reported outcomes of the Clareon PanOptix (CP) hydrophobic acrylic trifocal IOL in eyes with previous myopic laser refractive surgery (LRS).
Methods
This single‐center, ambispective study included 94 eyes of 47 patients with previous myopic LRS undergoing CP implantation. At 6 months, monocular visual acuity (VA), refraction, and refractive outcomes were assessed. Prediction accuracy was compared using Barrett True‐K and Haigis‐L with conventional keratometry (CK) or total keratometry (TK) on the IOLMaster 700 and Barrett True‐K with CK or TK on the Argos; Argos TK incorporated Pentacam‐measured posterior corneal astigmatism. Spectacle dependence, satisfaction, and visual disturbances were assessed. Correlations between preoperative corneal higher‐order aberrations (HOAs) and postoperative outcomes were analyzed.
Results
Mean uncorrected VAs were 0.028 ± 0.087 logMAR for distance, 0.177 ± 0.130 logMAR for intermediate, and 0.093 ± 0.137 logMAR for near. The mean postoperative spherical equivalent was −0.142 ± 0.375 D, with 81% of eyes within ±0.50 D of emmetropia. In a retrospective comparison of IOL power calculation methods, Barrett True‐K with TK on the IOLMaster 700 yielded the highest observed proportion of eyes within ±0.50 D of the intended target (78.7%). After Holm–Bonferroni correction, preoperative corneal HOA RMS and nonspherical HOA RMS at a 3.0‐mm diameter were associated with uncorrected distance VA, whereas corneal HOAs at larger analysis diameters (5.0–6.0 mm) were associated with postoperative visual disturbances. Patients reported high satisfaction (3.09 ± 0.62) and complete spectacle independence for distance and intermediate vision.
Conclusions
The CP trifocal IOL is an effective option for presbyopia correction in post‐myopic LRS eyes meeting predefined preoperative corneal aberration criteria. Refractive predictability depended on device‐specific formula–keratometry combinations, with Barrett True‐K yielding the highest observed ±0.50 D rates with TK (IOLMaster 700) and with CK (Argos). Corneal HOA analysis at specified measurement diameters may further guide patient selection and counseling.