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Bilateral implantation of +3.0 D multifocal toric intraocular lenses: results of a US Food and Drug Administration clinical trial

Authors Lehmann R, Modi S, Fisher B, Michna M, Snyder M

Received 18 March 2017

Accepted for publication 30 May 2017

Published 20 July 2017 Volume 2017:11 Pages 1321—1331


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Robert Lehmann,1 Satish Modi,2 Bret Fisher,3 Magda Michna,4 Michael Snyder5

1Lehmann Eye Center, Nacogdoches, TX, 2Seeta Eye Center, Poughkeepsie, NY, 3The Eye Center of North Florida, Panama City, FL, 4Department of Clinical Trial Management, Alcon Laboratories, Inc., Fort Worth, TX, 5Cincinnati Eye Institute, Cincinnati, OH, USA

Purpose: The purpose of this study was to evaluate the clinical outcomes of apodized diffractive +3.0 D multifocal toric intraocular lens (IOL) implantations in subjects with preoperative corneal astigmatism.
Patients and methods: This was a prospective cohort study conducted at 21 US sites. The study population consisted of 574 subjects, aged ≥21 years, with preoperative astigmatism 0.75–2.82 D, and potential postoperative visual acuity (VA) ≥0.2 logMAR, undergoing bilateral cataract removal by phacoemulsification. The intervention was bilateral implantation of aspheric apodized diffractive +3.0 D multifocal toric or spherical multifocal nontoric IOLs. The main outcome measures were monocular uncorrected near and distance VA and safety at 12 months.
Results: A total of 373/386 and 182/188 subjects implanted with multifocal toric and nontoric IOLs, respectively, completed 12-month follow-up after the second implantation. Toric IOLs were noninferior in monocular uncorrected distance (4 m) and near (40 cm) VA but had >1 line better binocular uncorrected intermediate VA (50, 60, and 70 cm) than nontoric IOLs. Toric IOLs reduced cylinder to within 0.50 D and 1.0 D of target in 278 (74.5%) and 351 (94.1%) subjects, respectively. Mean ± standard deviation (SD) differences between intended and achieved axis orientation in the first and second implanted eyes were 5.0°±6.1° and 4.7°±4.0°, respectively. Mean ± SD 12-month IOL rotations in the first and second implanted eyes were 2.7°±5.8° and 2.2°±2.7°, respectively. No subject receiving toric IOLs required secondary surgical intervention due to optical lens properties.
Conclusion: Multifocal toric IOLs were noninferior to multifocal nontoric IOLs in uncorrected distance and near VAs in subjects with preexisting corneal astigmatism and effectively corrected astigmatism of 0.75–2.82 D.

Keywords: AcrySof® IQ ReSTOR, corneal astigmatism, phacoemulsification, target cylinder, axis orientation, IOL rotation lens, visual acuity

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