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Developments in cataract and refractive surgery are driven by permanently growing demands for the recovery of a visual ability as close as possible to adolescence vision, especially regarding compensation of presbyopia. Up to now, all approaches intending a restoration of physiological accommodation, for example, by implementation of an accommodative intraocular lens (IOL), have failed. However, the use of multifocal optics, which simultaneously create multiple foci to produce sharp images of objects at different focal planes, has increasingly established over the last two decades. Nevertheless, even with current models of multifocal IOLs (MIOLs), postoperative issues which derogate patient's satisfaction to a significant extent might occur and can be very challenging for the physician. A relatively new option, which offers an alternative in case of incompatibility of the multifocal optic, is the implantation of an additional pseudophakic IOL. These lenses are inserted into the sulcus ciliaris in addition to the previously or simultaneously implanted IOL in the capsular bag. Thereby, they allow a chronologically flexible procedure of the implantation of the multifocal part of the optic and, if necessary, a reversibility of the intervention. The modern additional lenses differ fundamentally from formerly used piggyback-IOLs. Due to the design specifically optimised for their implantation site, problems such as ingrowth of epithelium between both IOLs, pigment abrasion of the back surface of the iris as well as postoperative intraocular pressure rise and enhanced inflammatory response are no longer observed. 1 2
Our study compares the clinical results and the intraoperative and postoperative performance of an additional multifocal IOL (Diff-sPB, HumanOptics AG) with a conventional MIOL (Diff-aA, HumanOptics AG) implanted in the capsular bag. Both IOLs are based on the same multifocal optic, thereby allowing a direct comparison of the different methods.
Patients and methods
In this prospective, randomised, monocentric study, cataract surgery was performed in 67 eyes of 38 patients. Patients were divided into two groups: the eyes of group A were simultaneously implanted with a monofocal IOL in the capsular bag and an additional multifocal IOL in the sulcus ciliaris. The eyes of group B received a single MIOL in the capsular bag.
The study involved patients between 40 and 85 years of age with the wish of a high degree of independence from glasses and an...