Although intraocular lenses (IOLs) have been explanted for decades, the explantation of multifocal (MF) IOLs has been an increasing recent phenomenon. MF IOLs are explanted because patients complain of dysphotopsias and blurred vision associated in some cases to posterior capsule opacification (PCO) and refractive error that can be easily managed with YAG-capsulotomy, spectacles, and keratorefractive surgery. However, we lack effective treatments for subjective complaints especially the feeling of inadequate or poor vision as well as photic phenomena experienced with both refractive and diffractive MF IOL models. New reports proved that cortical neural areas are responsible for the long-term adaptation to such visual symptoms, suggesting that their persistence is a neuroadaptation failure. Eventually, the only solution in such cases would be the explantation of the MF IOL. The studies available in the literature report the outcomes of MF IOLs exchange to monofocal IOLs, though no relevant investigation was carried out on the exchange of MF IOLs to another MF IOL technologies. Our group is conducting such a study where MF IOLs were explanted due to neuroadaptation failure followed by the re-implantation of a different MF optical technology based on the hypothesis that there may be different neuroadaptation processes for refractive and diffractive IOLs in different patients. Into neuroadaptation failure we included all the subjective visual symptoms that did not have any clear anatomical cause such as photic phenomena, blurred vision, insufficient vision, and monocular diplopia. We had excellent results with an increase in both far and near visual acuities and improvement of patients’ quality of life and vision assessed by validated questionnaires. This procedure showed to be feasible and able to correct the patient’s dissatisfaction and keep the advantages of MF IOLs such as spectacle independence in the benefit of the patient.
This is a preview of subscription content, log in to check access.
Compliance with Ethical Requirements
Conflict of Interest
Olena Al-Shymali and Jorge Alió declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.
No animal studies were carried out by the authors for this article.
Mojzis P, Peña-García P, Liehneova I, Ziak P, Alió J. Outcomes of a new diffractive trifocal intraocular lens. J Cataract Refract Surg. 2014;40(1):60–9.CrossRefGoogle Scholar
Alió J, Kaymak H, Breyer D, Cochener B, Plaza-Puche A. Quality of life related variables measured for three multifocal diffractive intraocular lenses: a prospective randomised clinical trial. Clin Exp Ophthalmol. 2018;46(4):380–8.CrossRefGoogle Scholar
Alio J, Plaza-Puche A, Férnandez-Buenaga R, Pikkel J, Maldonado M. Multifocal intraocular lenses: an overview. Surv Ophthalmol. 2017;62(5):611–34.CrossRefGoogle Scholar
Rosen E, Alió J, Dick H, Dell S, Slade S. Efficacy and safety of multifocal intraocular lenses following cataract and refractive lens exchange: metaanalysis of peer-reviewed publications. J Cataract Refract Surg. 2017;42(2):310–28.CrossRefGoogle Scholar
Alió J, Grabner G, Plaza-Puche A, Rasp M, Piñero D, Seyeddain O, et al. Postoperative bilateral reading performance with 4 intraocular lens models: six-month results. J Cataract Refract Surg. 2011;37(5):842–52.CrossRefGoogle Scholar
Xu Z, Li W, Wu L, Xue S, Chen X, Wu Q. Comparison of the clinical performance of refractive rotationally asymmetric multifocal IOLs with other types of IOLs: a meta-analysis. J Ophthalmol. 2018;2018:47282.Google Scholar
Llovet-Rausell A, Llovet-Osuna F, Bilbao-Calabuig R, Martínez Del Pozo M, Ortega-Usobiaga J, Baviera-Sabater J. Visual outcomes, spectacle independence and satisfaction after diffractive trifocal intraocular lens implantation. Arch Soc Esp Oftalmol. 2018;93(10):481–90.CrossRefGoogle Scholar
Alió J, Plaza-Puche A, Alió Del Barrio J, Amat-Peral P, Ortuño V, Yébana P, et al. Clinical outcomes with a diffractive trifocal intraocular lens. Eur J Ophthalmol. 2018;28(4):419–24.CrossRefGoogle Scholar
Mencucci R, Favuzza E, Caporossi O, Savastano A, Rizzo S. Comparative analysis of visual outcomes, reading skills, contrast sensitivity, and patient satisfaction with two models of trifocal diffractive intraocular lenses and an extended range of vision intraocular lens. Graefes Arch Clin Exp Ophthalmol. 2018;256(10):1913–22.CrossRefGoogle Scholar
Cochener B, Boutillier G, Lamard M, Auberger-Zagnoli C. A comparative evaluation of a new generation of diffractive trifocal and extended depth of focus intraocular lenses. J Refract Surg. 2018;34(8):507–14.CrossRefGoogle Scholar
Calvo-Sanz J, Sánchez-Tena M. Characterization of optical performance with defocusing curve: analysis of two refractive intraocular lens models with high and medium addition. J Optom. 2018;. pii: S1888–4296(18)30086-4. [Epub ahead of print]Google Scholar
Plaza-Puche A, Alio J. Analysis of defocus curves of different modern multifocal intraocular lenses. Eur J Ophthalmol. 2016;26(5):412–7.CrossRefGoogle Scholar
Ortiz D, Alió J, Bernabéu G, Pongo V. Optical performance of monofocal and multifocal intraocular lenses in the human eye. J Cataract Refract Surg. 2008;34(5):755–62.CrossRefGoogle Scholar
Hayashi K, Hirata A, Hayashi H. Possible predisposing factors for in-the-bag and out-of-the-bag intraocular lens dislocation and outcomes of intraocular lens exchange surgery. Ophthalmology. 2007;114(5):969–75.CrossRefGoogle Scholar
Pieh S, Lackner B, Hanselmayer G, Zöhrer R, Sticker M, Weghaupt H, et al. Halo size under distance and near conditions in refractive multifocal intraocular lenses. Br J Ophthalmol. 2001;85(7):816–21.CrossRefGoogle Scholar
de Vries N, Webers C, Touwslaqer W, Bauer N, de Brabander J, Berendschot T, et al. Dissatisfaction after implantation of multifocal intraocular lenses. J Cataract Refract Surg. 2011;37(5):859–65.CrossRefGoogle Scholar
Woodward M, Randleman J, Stulting R. Dissatisfaction after multifocal intraocular lens implantation. J Cataract Refract Surg. 2009;35(6):992–7.CrossRefGoogle Scholar
Gibbons A, Ali T, Waren D, Donaldson K. Causes and correction of dissatisfaction after implantation of presbyopia-correcting intraocular lenses. Clin Ophthalmol. 2016;10:1965–70.CrossRefGoogle Scholar
Rosa A, Miranda Â, Patrício M, McAlinden C, Silva F, Murta J, et al. Functional magnetic resonance imaging to assess the neurobehavioral impact of Dysphotopsia with multifocal intraocular lenses. Ophthalmology. 2017;124(9):1280–9.CrossRefGoogle Scholar
Rosa A, Miranda Â, Patrício M, McAlinden C, Silva F, Castelo-Branco M, et al. Functional magnetic resonance imaging to assess neuroadaptation to multifocal intraocular lenses. J Cataract Refract Surg. 2017;43(10):1287–96.CrossRefGoogle Scholar
Kim E, Sajjad A, Montes de Oca I, Koch D, Wang L, Weikert M, et al. Refractive outcomes after multifocal intraocular lens exchange. J Cataract Refract Surg. 2017;43(6):761–6.CrossRefGoogle Scholar
Fernández-Buenaga R, Alio J, Muñoz-Negrete F, Barraquer Compte R, Alio-Del Barrio J. Causes of IOL explantation in Spain. Eur J Ophthalmol. 2012;22(5):762–8.CrossRefGoogle Scholar
Kamiya K, Hayashi K, Shimizu K, Negishi K, Sato M, Bissen-Miyajima H, et al. Multifocal intraocular lens explantation: a case series of 50 eyes. Am J Ophthalmol. 2014;158(2):215–20.CrossRefGoogle Scholar
Tassignon M, Bartholomeeusen E, Rozema J, Jongenelen S, Mathysen D. Feasibility of multifocal intra-ocular lens exchange and conversion to the bag-in-the-lens implantation. Acta Ophthalmol. 2014;92(3):265–9.CrossRefGoogle Scholar
Galor A, Gonzalez M, Goldman D, O’Brien T. Intraocular lens exchange surgery in dissatisfied patients with refractive intraocular lenses. J Cataract Refract Surg. 2009;35(10):1706–10.CrossRefGoogle Scholar
Jones J, Jones Y, Jin G. Indications and outcomes of intraocular lens exchange during a recent 5-year period. Am J Ophthalmol. 2014;157(1):154–62.CrossRefGoogle Scholar
Davies E, Pineda R 2nd. Intraocular lens exchange surgery at a tertiary referral center: indications, complications, and visual outcomes. J Cataract Refract Surg. 2016;42(9):1262–7.CrossRefGoogle Scholar
Mamalis N, Brubaker J, Davis D, Espandar L, Werner L. Complications of foldable intraocular lenses requiring explantation or secondary intervention-2007 survey update. J Cataract Refract Surg. 2008;34(9):1584–91.CrossRefGoogle Scholar
Al-Shymali O, McAlinden C, Alió J. Outcomes of multifocal intraocular lens exchange by a different multifocal technology in patients with neuroadaptation failure. Manuscript submitted for publication; 2018;Google Scholar
Van der Mooren M, Steinert R, Tyson F, Langeslag M, Piers P. Explanted multifocal intraocular lenses. J Cataract Refract Surg. 2015;41(4):873–7.CrossRefGoogle Scholar
Wilkins M, Allan B, Rubin G, Findl O, Hollick E, Bunce C, et al. Randomized trial of multifocal intraocular lenses versus monovision after bilateral cataract surgery. Ophthalmology. 2013;120(12):2449–55.CrossRefGoogle Scholar
McAlinden C, Skiadaresi E, Khadka J, Pesudovs K. Pupil size and LASIK. Ophthalmology. 2012;119(8):1715–6.CrossRefGoogle Scholar