Long-term clinical effect of aspheric multifocal intraocular lens implantation for developmental cataracts in childhood

Objective

To observe the long-term visual quality and clinical effect of aspheric diffractive multifocal intraocular lens (IOL) implantation for congenital and developmental cataracts in childhood.

Methods

A retrospective cohort study on multifocal IOL implantation for congenital and developmental cataracts in childhood (aged 8 to 14 years) was performed in the First Affiliated Hospital of Zhengzhou University from August 2013 to January 2015.The clinical data of 67 eyes from 46 congenital cataract patients who received phacoemulsification with IOL implantation were collected.The AMO (ZMB00) IOL was implanted in 34 eyes of 24 patients in the multifocal IOL group, and Bausch & Lomb (MI60) IOL was implanted in 33 eyes of 22 patients in the monofocal IOL group.The distance, intermediate and near vision acuity were analyzed in 3, 6 and 12 months after surgery, including uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA). The wavefront aberrations, modulation transfer functions (MTF) and stereopsis were obtained with iTrace Analysis System, Optec-6500 Visual Functional Analyzer and Titmus Stereo Test Chart, respectively in 12 months after surgery.The near additional degree, removing glasses rate and myopic shift were compared between the two groups in postoperative 12 months.

Results

The intermediate and near UCVA in the multifocal IOL group were obviously better than those in the monofocal IOL group 3, 6 and 12 months after surgery (intermediate: Z=-3.74, -4.36, -3.66; all at P=0.00.near: Z=-2.67, -2.50, -2.33; all at P<0.05). There were no significant differences between the two groups in total aberration, high and low order total aberrations, comatic aberration, trefoil aberration, spherical aberration and secondary astigmatism under the 5.0 mm optical zone in 12 months after surgery (all at P>0.05). The MTFs under the 5.0 mm optical zone and 5, 10, 15, 20, 25, 30 c/d in the multifocal IOL group were insignificantly lower than those in the monofocal IOL group (all at P>0.05). In addition, the near stereopsis, near additional degree and myopic shift (ΔD) were reduced in the multifocal IOL group compared with monofocal IOL group (both at P<0.05). The glasses removing rate was 93.3% in the multifocal IOL group, which was significantly higher than 33.3% in the monofocal IOL group (χ²=23.25, P=0.00). No significant difference in the incidence of posterior capsular opacification was found between the two groups (P>0.05). The myopic shifting rates were 16.7% and 83.3% in the multifocal IOL group and monofocal IOL group, with a significant difference between the two groups (χ²=15.02, P=0.00).

Conclusions

The aspheric multifical IOL implantation can achieve good and stable distance, intermediate and near visual acuities, provide better near stereopsis, reduce postoperative dependence on spectacles and decrease the incidence of myopic shift in child cataract patients.

Congenital cataract; Intraocular lens; Prosthesis implantation; Aspheric; Multifocal; Wavefront aberration; Modulation transfer function; Childhood