Long-term clinical outcomes obtained with bilateral implantation of a multifocal intraocular lens through two different-sized corneal incisions

PURPOSE: To evaluate the long-term visual function and patient satisfaction in patients implanted bilaterally with the same type of multifocal intraocular lens (MIOL), using either a 2.2 mm small corneal incision with bimanual irrigation/aspiration (I/A) or a conventional 2.75 mm incision with coaxial I/A. METHODS: Prospective nonrandomized study including 100 eyes of 50 patients who underwent bilateral implantation of ReSTOR SN6AD1 through a 2.2 mm or 2.75 mm corneal incision. Outcomes included visual function measures (near, intermediate, and distance visual acuity [VA]), achievement of targeted refraction and postoperative astigmatism. Patient satisfaction was evaluated using a subjective questionnaire. RESULTS: Three and 12 months postoperatively, distance uncorrected best VA (UBVA) was 0.98 ± 0.07, UBVA at 30 cm was J1 in 100% of cases and UBVA at 60 cm was J3 in 72% of cases. Targeted refraction was achieved in 84% of cases and postoperative astigmatism was −0.4 ± 0.3 diopters. There was no statistically significant difference in UBVA in all distances, targeted refraction and postoperative astigmatism between the small-incision bimanual and the conventional coaxial group. Sixty percent of the patients were satisfied, 30% were very satisfied and 10% declared that the result did not meet their expectations. Three out of 5 nonsatisfied patients had an angle kappa of 4° and the MIOL was not well-centered. CONCLUSION: An incision size of 2.2 mm compared to 2.75 mm, did not appear to result in less surgically induced astigmatism after the implantation of a MIOL. SN6AD1 is a reliable MIOL choice for spectacle independence. Good preoperative patient selection is of crucial importance for the outcome in MIOLs.