Clinical outcomes of combined presbyopia and astigmatism correction following hydrophilic trifocal toric intraocular lens implantation in cataract patients: a prospective clinical study

Abstract Background Presbyopia and corneal astigmatism frequently coexist in cataract patients, reducing visual quality and increasing spectacle dependence. Toric trifocal intraocular lenses (IOLs) aim to address both conditions simultaneously. This prospective study evaluated the visual performance, quality, patient satisfaction, and safety profile of the Liberty 677MTY toric IOL, and classified its functional profile based on distance-corrected monocular defocus curve analysis. Methods This prospective, single-center, non-comparative clinical investigation included 28 eligible cataract patients with corneal astigmatism (1.00–6.00 D) who underwent bilateral implantation of the Liberty 677MTY trifocal toric IOL. Uncorrected and distance-corrected visual acuities at all distances, subjective refraction, IOL rotational stability, defocus curves, contrast sensitivity, patient-reported visual function, and safety were reported during a 12-month follow-up period. Results The Liberty 677MTY IOL demonstrated significant improvements ( p < 0.05) in uncorrected and distance-corrected visual acuities and subjective refractive cylinder, with stability over time. IOL alignment was stable through follow-up, with mean signed and absolute rotations of < 2° and < 5°, respectively. Binocular visual acuity defocus curves showed visual acuities better than 0.2 logMAR across the range of + 1.00 to ‑3.50 D. Monocular visual acuity defocus analysis confirmed full range of field smooth (FRoF-Sm) classification of the IOL. Contrast sensitivity defocus curve met acceptance criteria. Based on patient-reported outcomes 89% rated satisfaction as high, and 83% reported mild or no difficulty with visual disturbances. At 12 months, spectacle independence was achieved in 96.3% of patients for far, 81.5% for intermediate, and 92.6% for near vision. Safety analysis revealed one Nd: YAG-treated PCO case (1.61%) and no other IOL-related adverse events. Conclusions This study provides a detailed evaluation of the Liberty 677MTY trifocal toric IOL, integrating real-life binocular visual experience with comprehensive monocular assessments. The lens demonstrated predictable refractive outcomes, excellent rotational stability, and consistently high-quality vision across all distances, with strong patient satisfaction. Classified as FRoF-Sm by monocular defocus curve analysis, the lens offers continuous functional vision. By integrating monocular and binocular perspectives, these findings offer a clearer understanding of the lens’s performance, supporting its use as a safe and effective solution for achieving spectacle independence and enhancing postoperative quality of life.