PMC6173176_01
Photographic image of the single-piece trifocal IOL (Pod F FINE VISION).. Abbreviation: IOL, intraocular lens.
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IOL with double C-loop haptics (Pod F FINE VISION, PhysIOL, Liege, Belgium) (Figure 1) was scheduled for both eyes. In the right eye, a trifocal diffractive IOL was implanted following a straightforward FLACS procedure.
Intraoperative image taken during femtosecond laser surgery.. Notes: (A) 5.0 mm diameter CCC centered on White-to-White (pink circle). (B) Nuclear fragmentation using the cylinder and chop mode (yellow circle and eight pattern).. Abbreviation: CCC, curvilinear capsulorhexis.
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As planned, FLACS was performed using the femtosecond laser (LenSx, Alcon Laboratories, Fort Worth, TX, USA); 5.0 mm capsulotomy centered on White-to-White was created with 8.0 mJ of energy (spot and layer separations: 9 microm each) (Figure 2A). Nuclear fragmentation was performed using the chop and cylinder technique with 8.0 mJ of energy (spot and layer separations: 9 microm each) (Figure 2A). An optical coherence tomography (OCT) line scan indicated that there was no abnormality in the posterior capsule (Figure 2B).
Image of the development of the posterior capsule foramen at the 9 o'clock position (red arrow).
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While the cortex was aspirated, the posterior capsule foramen developed at the 9 o'clock position (Figure 3).
Photographic image of the three-piece +4.0 D bifocal IOL (ZMA00).. Abbreviation: IOL, intraocular lens.
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Consequently, a three-piece +4.0 D bifocal diffractive IOL with single C-loop haptics (Tecnis multifocal ZMA00, Abbott Medical Optics Inc., Santa Ana, CA, USA) (Figure 4) was placed in the sulcus using optic capture (Figure 5).
Image of optic capture involving the three-piece +4.0 D bifocal IOL.. Note: The CCC is indicated by the red arrow.. Abbreviations: CCC, curvilinear capsulorhexis; IOL, intraocular lens.
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Consequently, a three-piece +4.0 D bifocal diffractive IOL with single C-loop haptics (Tecnis multifocal ZMA00, Abbott Medical Optics Inc., Santa Ana, CA, USA) (Figure 4) was placed in the sulcus using optic capture (Figure 5).
(A) Defocus curve of the Fine Vision trifocal IOL (navy) ZMA00 bifocal IOL (green); right eye with the trifocal IOL (red) and left eye with the bifocal IOL (brown). The defocus curve for the Fine Vision trifocal IOL (navy) and ZMA00 bifocal IOL (green) was provided by the manufacturers. (B) Defocus curve for the right eye with the Fine Vision trifocal IOL (red); left eye with the ZMA00 bifocal IOL (brown) and both eyes (light blue).. Abbreviation: IOL, trifocal intraocular lens.
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The defocus curve in each eye was similar to the one in the trifocal IOL and the bifocal IOL, which were provided by the manufacturers (Figure 6A). A binocular defocus curve showed that the strength of each IOL compensated for the weaknesses in each type of IOL (Figure 6B).
Postoperative contrast sensitivity in both eyes.. Note: The shaded area indicates the normal range.
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A contrast sensitivity test (Contrast Glaretester, Takagi, Japan) indicated that the contrast sensitivity in both eyes was within the normal range (Figure 7).
Image of the anterior segment OCT.. Notes: R: right eye with the single-piece trifocal IOL in the bag. L: left eye with the three-piece bifocal IOL in the sulcus of the optic capture. Degree of tilt and decentration is indicated by the red box.. Abbreviations: IOL, intraocular lens; OCT, optical coherence tomography.
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Anterior segment OCT (CASIA2, Tomey, Nagoya, Japan) showed that the degree of both tilt (degree) and decentration (mm) in the single-piece trifocal IOL implanted in the bag (9.9 and 0.49 mm) was higher than the three-piece bifocal IOL implanted in the sulcus using optic capture (2.3 and 0.10 mm) (Figure 8).