Abstract / Summary
BackgroundSelecting intraocular lenses (IOLs) for cataract patients with long axial length remains challenging. Two diffractive toric IOLs with distinct design combinations—differing in material (hydrophobic vs. hydrophilic acrylic), optical design (trifocal vs. bifocal), haptic configuration (C-loop vs. plate-haptic), and IOL color (yellow-tinted vs. clear)—represent commonly used options. This study compared their long-term visual outcomes and rotational stability. Notably, this study was not designed to isolate individual contributions of material or IOL color, as these factors covary; posterior capsule opacification (PCO) and Nd:YAG capsulotomy rates were not systematically evaluated.MethodsThis retrospective case series enrolled 57 patients (57 eyes) undergoing cataract surgery with toric multifocal IOL implantation (January–December 2023), including 29 eyes receiving the hydrophobic trifocal IOL and 28 eyes receiving the hydrophilic bifocal IOL. Sample size was based on IOL rotation as the primary endpoint (≥25 eyes per group to detect a 3° difference, 80% power, α=0.05). Inclusion criteria required axial length ≥25.0 mm and corneal astigmatism >0.75 D. Patients were followed at 1 week, 1 month, and 3 months postoperatively. Primary endpoint was IOL rotation at 3 months; secondary endpoints included uncorrected visual acuity, corneal astigmatism, defocus curve, objective visual quality, and satisfaction scores.ResultsAt 3 months, mean rotation was (2.83 ± 2.56)° in the hydrophobic trifocal group and (3.25 ± 2.29)° in the hydrophilic bifocal group (P > 0.05). At 1 month, uncorrected intermediate visual acuity (LogMAR) was significantly better in the hydrophobic trifocal group (0.01 ± 0.07 vs. 0.16 ± 0.09, P < 0.001). Cumulative uncorrected distance visual acuity of 0.1 LogMAR or better was achieved in 96.6% and 92.9% of eyes, respectively. No significant differences were found in uncorrected distance and near visual acuity, total higher-order aberrations, Strehl ratio, or questionnaire scores. Both IOLs achieved comparable visual quality and rotational stability despite design differences.ConclusionsBoth diffractive toric multifocal IOLs demonstrate comparable long-term visual outcomes and rotational stability in cataract patients with long axial length. Differences in material, haptic configuration, and IOL color did not result in significant visual quality disparities. The trifocal design demonstrates advantages in intermediate visual acuity.