5-Year Trifocal IOL Outcomes in Chinese Cataract Patients: Visual Performance, Stability, and Satisfaction

Lulu Chen; Lu Sun; Yongxiang Tang; Wenda Sui; Ailing Bian; Xia Zhang; Zaowen Wang; Yong Zhong; Shunhua Zhang

doi:10.1016/j.ajo.2025.06.047

5-Year Trifocal IOL Outcomes in Chinese Cataract Patients: Visual Performance, Stability, and Satisfaction

Am J Ophthalmol. 2025 Jun 28:S0002-9394(25)00344-7. doi: 10.1016/j.ajo.2025.06.047. Online ahead of print.

Authors

Lulu Chen¹, Lu Sun¹, Yongxiang Tang², Wenda Sui¹, Ailing Bian¹, Xia Zhang¹, Zaowen Wang¹, Yong Zhong¹, Shunhua Zhang³

Affiliations

¹ Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, Beijing, China.
² Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China.
³ Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, Beijing, China. Electronic address: pumchzhang@hotmail.com.

PMID: 40588208
DOI: 10.1016/j.ajo.2025.06.047

Abstract

Purpose: To evaluate the 5-year visual outcomes, refractive stability, IOL centration, patient satisfaction, and complications following trifocal intraocular lens (IOL) implantation in a Chinese cohort.

Design: Retrospective study.

Subjects: This study included 33 patients (66 eyes) with bilateral implantation of the AT LISA 839MP trifocal IOL.

Methods: Postoperative assessments at 5 years included uncorrected and corrected distance, intermediate and near visual acuity, refractive outcomes, contrast sensitivity (CS), defocus curves, reading speed, and patient-reported outcomes (VFQ-25 questionnaire). IOL tilt/decentration and aberrometry were analyzed using anterior segment optical coherence tomography (AS-OCT) and iTrace visual function analyzer.

Main outcome measures: Postoperative outcomes at 5 years: uncorrected and corrected visual acuity (distance, intermediate, near), refractive results, and IOL centration.

Results: At 5 years, mean UDVA, UIVA, and UNVA were 0.06 ± 0.16, 0.10 ± 0.14, and 0.09 ± 0.12 logMAR, respectively. 92.4% of eyes achieved a postoperative spherical equivalent within ±1.0D. Over 87.9% of patients achieved spectacle independence. Mean IOL tilt was 4.19 ± 1.46° and mean IOL decentration was 0.21 ± 0.11 mm. Contrast sensitivity declined under glare, particularly at mesopic conditions. Moderate-to-severe halos were reported by 21.2% of patients, correlating significantly with IOL tilt (4.79 ± 1.16° vs. 3.75 ± 1.45° in mild cases, p=0.021). Posterior capsule opacification necessitated Nd:YAG capsulotomy in 63.6% of eyes (mean intervention time: 22.0 ± 9.9 months), with no complications post-procedure. Patient satisfaction remained high (VFQ-25 score: 93.9 ± 13.7), despite persistent dysphotopsias.

Conclusion: Trifocal IOLs provided long-term efficacy in visual acuity, refractive stability, and exceptional patient satisfaction among Chinese populations. However, PCO remains a prevalent late complication, requiring timely Nd:YAG intervention. IOL tilt significantly influences halo severity.

Keywords: efficacy; long-term; patient satisfaction; trifocal intraocular lens.