Aphakic eyes that have no or inadequate capsular support can pose a significant challenge to cataract surgeons. Careful attention to the preoperative considerations, appropriate intraocular lens choices, surgical techniques, and postoperative management can ensure optimal results.
Trifocal IOLs can provide good uncorrected vision at near, intermediate, and far. Outcomes in a series of 30 patients show that a toric version of a trifocal IOL (AT Lisa tri 939MP, Carl Zeiss Meditec) delivers those benefits for patients with > 1 D of corneal astigmatism.
Multifocal IOLs offer the potential to reduce spectacle dependence, but outcomes vary depending on optical design. Optimizing success and satisfaction depends on careful patient selection, thorough counseling, and good surgical technique.
A new non-apodized diffractive trifocal IOL allows 88% energy utilization and sends energy to near (40 cm), a preferred intermediate distance (60 cm), and far (infinity). Early results for visual acuity, contrast sensitivity, and photopic symptoms are encouraging.
Multifocal IOLs with a trifocal diffractive optic design are available outside of the United States. They provide good visual acuity for distance, intermediate, and near and appear to provide slightly better intermediate vision than bifocal diffractive multifocal IOLs.