• Cataract/Anterior Segment

    Review of: Trifocal intraocular lens implantation in eyes with previous corneal refractive surgery for myopia and hyperopia

    Cobo-Soriano R, Ortega-Usobiaga J, Rodríguez-Gutiérrez B, et al. Journal of Cataract and Refractive Surgery, October 2021

    Retrospective patient data were reviewed to explore visual and refractive outcomes in eyes implanted with trifocal intraocular lenses (IOLs) following laser keratorefractive surgery for myopia or hyperopia.

    Study design

    This retrospective study, conducted in Spain, investigated the outcomes of trifocal intraocular lens (IOL) placement after phacoemulsification in 868 eyes that previously underwent myopic (37%) or hyperopic (63%) laser keratorefractive surgery. The primary outcome measures were visual acuity and manifest refraction at both the third month visit and the final available visit, with at least 3 months of post-lensectomy follow-up.


    Three months after cataract surgery, logMAR corrected distance visual acuity (CDVA) was significantly worse in the hyperopic group than the myopic group (0.06 ± 0.05 vs. 0.04 ± 0.04, respectively). The uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA) were similar between both groups. The hyperopic group had a higher percentage of eyes that lost more than 1 line of CDVA from preoperative baseline CDVA, compared with the myopic group (21% vs. 12%, respectively). The mean manifest refraction spherical equivalent (MRSE) was significantly higher in the myopic group than the hyperopic group (−0.38 ± 0.30 D vs. −0.17 ± 0.30 D). Subgroup analysis showed that the residual refractive error was proportional to the degree of myopia or hyperopia prior to the laser keratorefractive surgery. Patients with high myopia beyond −5.00 D or with high hyperopia beyond +3.00 D before keratorefractive surgery had significantly higher mean MRSE than patients with low myopia or low hyperopia. The risk of losing CDVA was greater in patients with high hyperopia greater than +3.00 D prior to keratorefractive surgery.


    One limitation of this study is its retrospective design, which did not include assessment of subjective visual quality after trifocal IOL implantation such as dysphotopsia, contrast sensitivity, and spectacle dependence. US surgeons may also see limited benefit in this study as none of the 3 study IOLs are currently available in the United States.

    Clinical significance

    This study found that patients with a history of laser keratorefractive surgery for hyperopia were more likely to experience loss of more than 1 line of CDVA after trifocal IOL placement, compared with patients with a laser keratorefractive surgery for myopia. Conversely, eyes with a history of myopic laser keratorefractive surgery were more likely to have a refractive miss after trifocal IOL placement. While the study investigators concluded that implantation of a trifocal IOL can be safe and effective after laser keratorefractive surgery, surgeons implanting these IOLs should be aware of these findings.