Refractive lens extraction with trifocal intraocular lens implantation in high myopia and myopic astigmatism

In modern cataract surgery, the ophthalmologist aims not only to remove the lens but also to optimize the patient's refractive status. Refractive lens exchange allows correction of presbyopia and reduces spectacle dependence, particularly in patients with high myopia who are not suitable candidates for corneal procedures. OBJECTIVE: The study evaluated the postoperative outcomes of trifocal intraocular lenses (IOLs) implantation for correction of high myopia and myopic astigmatism. MATERIAL AND METHODS: This retrospective study, conducted at the Eye Microsurgery Ophthalmological Center in Chișinău (January-December 2023), analyzed data from 40 patients (75 eyes) who underwent refractive lens exchange with trifocal IOL implantation (Alcon PanOptix/PanOptix Toric). The patients were selected according to specific criteria, and all underwent comprehensive preoperative assessment. Surgery was performed by phacoemulsification under local anesthesia, followed by postoperative care. The 1-month follow-up included measurement of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), and corrected intermediate visual acuity (CIVA). RESULTS: The patients included in our study received two types of trifocal IOLs. Alcon IQ PanOptix IOLs were implanted in 81% of cases, and Alcon IQ PanOptix Toric IOLs - in 19%. After surgery, patients showed a substantial improvement in visual acuity: UDVA increased by 81%, UIVA - by 39%, uncorrected near visual acuity (UNVA) - by 12%, and CDVA and corrected near visual acuity (CNVA) - by 2%. Peripheral retinal degeneration was the most common ocular pathology - 47% (35 eyes). CONCLUSION: Trifocal IOL implantation in high myopia with myopic astigmatism provides high visual acuity, spectacle independence, and requires careful preoperative assessment.