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Multifocal intraocular lenses (MIOLs) are designed to reduce dependence on spectacles after cataract surgery or refractive lens exchange.1--3 There are two main MIOL designs: refractive and diffractive. Refractive MIOLs offer excellent distance and intermediate vision, as well as complete transmission of light,4 but they may produce night-vision photic symptoms, and near vision is inferior to diffractive MIOLs.5--7 Refractive MIOLs are pupil-dependent by definition, as they need a critical pupil diameter for the light to reach the different refractive areas of the lens.8 On the other hand, diffractive MIOLs offer excellent distance and near vision, they are relatively pupil independent, and patients experience fewer problems with night vision.9,10 However, diffractive MIOLs do not adequately address intermediate vision, as well as loss of transmitted light and, therefore, result in loss in contrast sensitivity.11
The combination of refractive and diffractive MIOLs has been called the "mix and match" or "custom matching" technique.12,13 This approach may offer a greater chance of spectacle independence by minimizing the problems inherent to each MIOL design. The Lentis Mplus (Oculentis GmbH, Berlin, Germany) is a new one-piece refractive MIOL. Patients bilaterally implanted with Lentis Mplus MIOLs have shown excellent distance and intermediate vision, 14--16 but near vision is inferior to that reported with diffractive MIOLs.9,10 The Acri.Lisa 366D (Acri.Tec GmbH, Hemmingsdorf, Germany) is a plate-optic diffractive MIOL that provides excellent distance and near vision, but insufficient intermediate vision.9,17--19
The purpose of this study was to evaluate the visual function of patients implanted with a Lentis Mplus MIOL in one eye and an Acri.Lisa MIOL in the fellow eye.
Patients and Methods
Enrollment and Baseline
This prospective study comprised patients having bilateral cataract surgery combining a rotationally asymmetric refractive MIOL (Lentis Mplus) in one eye and a diffractive MIOL (Acri.Lisa) in the fellow eye. Inclusion criteria were cataract causing a significant reduction in visual quality, potential visual acuity 0.3 logMAR or better (0.5 decimal), and corneal astigmatism 1.00 diopter (D) in both eyes. Exclusion criteria were ocular disease other than cataract and previous corneal refractive surgery. Patients with an axial length difference between eyes >0.3 mm were excluded. Patients were informed about the advantages and drawbacks of combining different designs of MIOLs. Written informed...