Preliminary clinical observation of unilateral implantation of trifocal intraocular lens

BACKGROUND: Evidence on unilateral trifocal IOL implantation is limited. This study evaluates the clinical outcomes of unilateral implantation of the AcrySof IQ PanOptix TFNT00 trifocal intraocular lens (IOL) in cataract patients. METHODS: This study included 55 eyes of 55 cataract patients who underwent unilateral TFNT00 trifocal IOL implantation. Comprehensive evaluations were performed preoperatively and postoperatively at 1, 3, 6, and 12 months. Outcome measures included uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and corrected distance visual acuity (CDVA); defocus curve analysis; objective optical quality parameters, including Strehl ratio (SR) and modulation transfer function area ratio (MTF-AR); reading performance; and dysphotopsia. Subjective visual function was quantified using the VF-14 Cataract Visual Function Questionnaire at 1 and 12 months postoperatively. RESULTS: At 12 months postoperatively, 76.4% of eyes achieved UDVA of 20/20 or better and 87.3% achieved a CDVA of 20/20 or better (≤ 0.0 logMAR). All eyes achieved UIVA and UNVA of 20/40 or better (≤ 0.3 logMAR). Refractive outcomes were stable and accurate, with 74.5% of eyes within ± 0.50 D of target spherical equivalent and a mean residual astigmatism of 0.25 ± 0.25 D at 12 months. Defocus curves demonstrated a bimodal profile with peaks at 0.00 to -0.50 D and - 2.00 to -2.50 D. Significant improvements were observed in objective optical quality parameters, Strehl ratio (SR) improved from 0.008 ± 0.007 preoperatively to 0.093 ± 0.023 at 12 months (P < 0.001), and modulation transfer function area ratio (MTF-AR) increased from 0.169 ± 0.060 to 0.413 ± 0.077 (P < 0.001). Reading performance showed marked enhancement in both reading acuity and speed (both P < 0.001). VF-14 questionnaire scores exceeded 3 points for all items. Glare or halos were reported by 3 eyes (5.5%) at 12 months; severity was not formally graded. CONCLUSION: Unilateral implantation of the TFNT00 trifocal IOL effectively restores distance, intermediate, and near vision in cataract patients, with favorable objective optical quality and a low incidence of photic phenomena. Patients reported satisfactory subjective visual function across a wide range of daily activities, suggesting effective neuroadaptation despite monocular correction. These preliminary findings support unilateral trifocal IOL implantation as a viable option for patients in whom bilateral surgery is not feasible or desired. However, given the exploratory nature of this study, further comparative research with larger cohorts is warranted to confirm these outcomes.