gms | German Medical Science

Advances in cataract surgery are expanding the visual capacity of patients for successful cataract extraction, which benefits the growing population of patients with multifocal intraocular lenses. However, implantation of a secondary intraocular lens (IOL) in the absence of a capsular bag is more challenging. We present the case of secondary multifocal intraocular lens implantation in a patient with a previous vitrectomy. Vitrectomy was performed 5 years ago for retinal detachment in both eyes, on the left eye in a combined procedure with phacoemulsification and monofocal IOL implantation. Preoperatively capsular bag phimosis with monofocal IOL displacement in the left dominant eye and nucleus cataract in the right eye were diagnosed. Since the primary visual requirements of the patient were distance and intermediate vision, a monofocal IOL was explanted in the left eye and implanted LENTIS Comfort MF15 (ADD +1.5 D) followed by four-point sutured scleral fixation, and LENTIS Mplus MF20 (ADD +2.0 D) was implanted in the right eye after phacoemulsification. Phacoemulsification and secondary implantations were successful, without obvious adverse events. Good vision in both eyes was achieved. One month postoperatively, the uncorrected distance visual acuity had increased from 1.30 logMAR to 0.0 logMAR in the right eye and remained unchanged 0.10 logMAR in the left eye. The uncorrected intermediate visual acuity (66 cm) was 0.08 logMAR binocularly. The uncorrected near visual acuity (40 cm) were 0.10 logMAR in the right eye and 0.20 logMAR in the left eye. Patient was completely satisfied with his visual functioning.

Conclusion: Secondary multifocal intraocular lens implantation demonstrated satisfactory outcomes without complications. This technology was safe and did not require complicated equipment and is of considerable interest in the setting without adequate capsule support patients to optimise distance and intermediate visual acuities. Despite the lower near addition of segmented bifocal IOL, acceptable spectacle independence was achieved.