Skip to main content
SpringerLink
Log in

Multifocal Intraocular Lenses: Complications

  • Chapter
  • First Online:
Multifocal Intraocular Lenses

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Abstract

In this chapter, the most common complications after multifocal IOL implantation, as well as the best way to manage them, are described. First of all, we focus on prevention. To achieve a high patient satisfaction, it is very important to use strategies to prevent or to minimize the risk of complications. The first step to avoid complications when implanting multifocal IOLs is an adequate patient selection. We show in this chapter the ophthalmological examination that is recommended prior to multifocal IOL implantation.

Then, the reasons for patient dissatisfaction are discussed in detail. Blurred vision is the leading complaint after multifocal implantation being reported in some series of patient dissatisfaction in almost 95 % of the cases. The etiology is attributed to residual ametropia and posterior capsule opacification in the majority of cases. Photic phenomenon is another common complaint. IOL explantation is the worst possible scenario after cataract surgery with multifocal IOL implantation. Fortunately, it is only needed in very few patients among those who complain.

In conclusion, patient satisfaction after multifocal IOL implantation is high, usually over 90 % of the cases. However, complications may also occur. In this chapter, all those possible complications, as well as the best strategies to overcome them, are discussed in depth. Fortunately, in more than 80 % of cases an improvement in patients’ symptoms is achieved with only conservative treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cillino S, Casuccio A, Di Pace F, et al. One-year outcomes with new-generation multifocal intraocular lenses. Ophthalmology. 2008;115:1508–16.

    Article  PubMed  Google Scholar 

  2. Kohnen T, Nuijts R, Levy P, et al. Visual function after bilateral implantation of apodized diffractive aspheric multifocal intraocular lenses with a +3.0 D addition. J Cataract Refract Surg. 2009;35:2062–9.

    Article  PubMed  Google Scholar 

  3. Alfonso JF, Fernandez-Vega L, Valcarcel B, et al. Outcomes and patient satisfaction after presbyopic bilateral lens exchange with the ResTOR IOL in emmetropic patients. J Refract Surg. 2010;26:927–33.

    Article  PubMed  Google Scholar 

  4. Woodward MA, Randleman JB, Stulting RD. Dissatisfaction after multifocal intraocular lens implantation. J Cataract Refract Surg. 2009;35:992–7.

    Article  PubMed  Google Scholar 

  5. de Vries NE, Webers CA, Touwslager WR, et al. Dissatisfaction after implantation of multifocal intraocular lenses. J Cataract Refract Surg. 2011;37(5):859–65.

    Article  PubMed  Google Scholar 

  6. Leyland M, Pringle E. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database Syst Rev. 2006;(4):CD003169.

    Google Scholar 

  7. Venter JA, Pelouskova M, Collins BM, et al. Visual outcomes and patient satisfaction in 9366 eyes using a refractive segmented multifocal intraocular lens. J Cataract Refract Surg. 2013;39:1477–84.

    Article  PubMed  Google Scholar 

  8. Jung CK, Chung SK, Baek NH. Decentration and tilt: silicone multifocal versus acrylic soft intraocular lenses. J Cataract Refract Surg. 2000;26:582–5.

    Article  CAS  PubMed  Google Scholar 

  9. Kim JS, Shyn KH. Biometry of 3 types of intraocular lenses using Scheimpflug photography. J Cataract Refract Surg. 2001;27:533–6.

    Article  CAS  PubMed  Google Scholar 

  10. Nejima R, Miyata K, Honbou M, et al. A prospective, randomised comparison of single and three piece acrylic foldable intraocular lenses. Br J Ophthalmol. 2004;88:746–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Taketani F, Matuura T, Yukawa E, Hara Y. Influence of intraocular lens tilt and decentration on wavefront aberrations. J Cataract Refract Surg. 2004;30:2158–62.

    Article  PubMed  Google Scholar 

  12. Mutlu FM, Erdurman C, Sobaci G, Bayraktar MZ. Comparison of tilt and decentration of 1-piece and 3-piece hydrophobic acrylic intraocular lenses. J Cataract Refract Surg. 2005;31:343–7.

    Article  PubMed  Google Scholar 

  13. Taketani F, Yukawa E, Yoshii T, et al. Influence of intraocular lens optical design on high-order aberrations. J Cataract Refract Surg. 2005;31:969–72.

    Article  PubMed  Google Scholar 

  14. Baumeister M, Neidhardt B, Strobel J, Kohnen T. Tilt and decentration of three-piece foldable high-refractive silicone and hydrophobic acrylic intraocular lenses with 6-mm optics in an intraindividual comparison. Am J Ophthalmol. 2005;140:1051–8.

    Article  PubMed  Google Scholar 

  15. Tabernero J, Piers P, Benito A, et al. Predicting the optical performance of eyes implanted with IOLs to correct spherical aberration. Invest Ophthalmol Vis Sci. 2006;47:4651–8.

    Article  PubMed  Google Scholar 

  16. Rosales P, Marcos S. Phakometry and lens tilt and decentration using a custom-developed Purkinje imaging apparatus: validation and measurements. J Opt Soc Am A Opt Image Sci Vis. 2006;23:509–20.

    Article  PubMed  Google Scholar 

  17. De Castro A, Rosales P, Marcos S. Tilt and decentration of intraocular lenses in vivo from Purkinje and Scheimpflug imaging. Validation study. J Cataract Refract Surg. 2007;33:418–29.

    Article  PubMed  Google Scholar 

  18. Oshika T, Sugita G, Miyata K, et al. Influence of tilt and decentration of scleral-sutured intraocular lens on ocular higher-order wavefront aberration. Br J Ophthalmol. 2007;91:185–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Soda M, Yaguchi S. Effect of decentration on the optical performance in multifocal intraocular lenses. Ophthalmologica. 2012;227:197–204.

    Article  PubMed  Google Scholar 

  20. Hayashi K, Hayashi H, Nakao F, Hayashi F. Correlation between pupillary size and intraocular lens decentration and visual acuity of a zonal-progressive multifocal lens and a monofocal lens. Ophthalmology. 2001;108:2011–7.

    Article  CAS  PubMed  Google Scholar 

  21. Eppig T, Scholz K, Loffler A, et al. Effect of decentration and tilt on the image quality of aspheric intraocular lens designs in a model eye. J Cataract Refract Surg. 2009;35:1091–100.

    Article  PubMed  Google Scholar 

  22. Park CY, Oh SY, Chuck RS. Measurement of angle kappa and centration in refractive surgery. Curr Opin Ophthalmol. 2012;23:269–75.

    Article  PubMed  Google Scholar 

  23. Crnej A, Hirnschall N, Nishi Y, et al. Impact of intraocular lens haptic design and orientation on decentration and tilt. J Cataract Refract Surg. 2011;37:1768–74.

    Article  PubMed  Google Scholar 

  24. Qatarneh D, Hau S, Tuft S. Hyperopic shift from posterior migration of hydrophilic acrylic intraocular lens optic. J Cataract Refract Surg. 2010;36:161–3.

    Article  PubMed  Google Scholar 

  25. van der Linden JW, van der Meulen IJ, Mourits MP, Lapid-Gortzak R. In-the-bag decentration of a hydrophilic radially asymmetric multifocal intraocular lens secondary to capsule contraction. J Cataract Refract Surg. 2013;39:642–4.

    Article  PubMed  Google Scholar 

  26. Alio JL, Pinero DP, Plaza-Puche AB, Chan MJ. Visual outcomes and optical performance of a monofocal intraocular lens and a new-generation multifocal intraocular lens. J Cataract Refract Surg. 2011;37:241–50.

    Article  PubMed  Google Scholar 

  27. Alio JL, Plaza-Puche AB, Javaloy J, et al. Clinical and optical intraocular performance of rotationally asymmetric multifocal IOL plate-haptic design versus C-loop haptic design. J Refract Surg. 2013;29:252–9.

    Article  PubMed  Google Scholar 

  28. Alio JL, Plaza-Puche AB, Pinero DP. Rotationally asymmetric multifocal IOL implantation with and without capsular tension ring: refractive and visual outcomes and intraocular optical performance. J Refract Surg. 2012;28:253–8.

    Article  PubMed  Google Scholar 

  29. Kim JH, Kim H, Joo CK. The effect of capsular tension ring on posterior capsular opacity in cataract surgery. Korean J Ophthalmol. 2005;19:23–8.

    Article  PubMed  Google Scholar 

  30. Lee DH, Lee HY, Lee KH, et al. Effect of a capsular tension ring on the shape of the capsular bag and opening and the intraocular lens. J Cataract Refract Surg. 2001;27:452–6.

    Article  CAS  PubMed  Google Scholar 

  31. Lee DH, Shin SC, Joo CK. Effect of a capsular tension ring on intraocular lens decentration and tilting after cataract surgery. J Cataract Refract Surg. 2002;28:843–6.

    Article  PubMed  Google Scholar 

  32. Rohart C, Gatinel D. Influence of a capsular tension ring on ocular aberrations after cataract surgery: a comparative study. J Refract Surg. 2009;25:S116–21.

    PubMed  Google Scholar 

  33. Sun R. Functions of the capsular tension ring. J Cataract Refract Surg. 2007;33:4.

    Article  PubMed  Google Scholar 

  34. Montes-Mico R, Espana E, Bueno I, et al. Visual performance with multifocal intraocular lenses: mesopic contrast sensitivity under distance and near conditions. Ophthalmology. 2004;111:85–96.

    Article  PubMed  Google Scholar 

  35. Choi J, Schwiegerling J. Optical performance measurement and night driving simulation of ReSTOR, ReZoom, and Tecnis multifocal intraocular lenses in a model eye. J Refract Surg. 2008;24:218–22.

    PubMed  Google Scholar 

  36. Artigas JM, Menezo JL, Peris C, et al. Image quality with multifocal intraocular lenses and the effect of pupil size: comparison of refractive and hybrid refractive-diffractive designs. J Cataract Refract Surg. 2007;33:2111–7.

    Article  PubMed  Google Scholar 

  37. Behndig A, Montan P, Stenevi U, et al. Aiming for emmetropia after cataract surgery: Swedish National Cataract Register study. J Cataract Refract Surg. 2012;38:1181–6.

    Article  PubMed  Google Scholar 

  38. Snead MP, Rubinstein MP, Lea SH, Haworth SM. Calculated versus A-scan result for axial length using different types of ultrasound probe tip. Eye (Lond). 1990;4(Pt 5):718–22.

    Article  Google Scholar 

  39. Pierro L, Modorati G, Brancato R. Clinical variability in keratometry, ultrasound biometry measurements, and emmetropic intraocular lens power calculation. J Cataract Refract Surg. 1991;17:91–4.

    Article  CAS  PubMed  Google Scholar 

  40. Raman S, Redmond R. Reasons for secondary surgical intervention after phacoemulsification with posterior chamber lens implantation. J Cataract Refract Surg. 2003;29:513–7.

    Article  PubMed  Google Scholar 

  41. Erickson P. Effects of intraocular lens position errors on postoperative refractive error. J Cataract Refract Surg. 1990;16:305–11.

    Article  CAS  PubMed  Google Scholar 

  42. Alfonso JF, Fernandez-Vega L, Montes-Mico R, Valcarcel B. Femtosecond laser for residual refractive error correction after refractive lens exchange with multifocal intraocular lens implantation. Am J Ophthalmol. 2008;146:244–50.

    Article  PubMed  Google Scholar 

  43. Leccisotti A. Secondary procedures after presbyopic lens exchange. J Cataract Refract Surg. 2004;30:1461–5.

    Article  PubMed  Google Scholar 

  44. Pop M, Payette Y, Amyot M. Clear lens extraction with intraocular lens followed by photorefractive keratectomy or laser in situ keratomileusis. Ophthalmology. 2001;108:104–11.

    Article  CAS  PubMed  Google Scholar 

  45. Ayala MJ, Perez-Santonja JJ, Artola A, et al. Laser in situ keratomileusis to correct residual myopia after cataract surgery. J Refract Surg. 2001;17:12–6.

    CAS  PubMed  Google Scholar 

  46. Norouzi H, Rahmati-Kamel M. Laser in situ keratomileusis for correction of induced astigmatism from cataract surgery. J Refract Surg. 2003;19:416–24.

    PubMed  Google Scholar 

  47. Muftuoglu O, Prasher P, Chu C, et al. Laser in situ keratomileusis for residual refractive errors after apodized diffractive multifocal intraocular lens implantation. J Cataract Refract Surg. 2009;35:1063–71.

    Article  PubMed  Google Scholar 

  48. Pinero DP, Espinosa MJ, Alio JL. LASIK outcomes following multifocal and monofocal intraocular lens implantation. J Refract Surg. 2010;26(8):569–77.

    Article  PubMed  Google Scholar 

  49. Habot-Wilner Z, Sachs D, Cahane M, et al. Refractive results with secondary piggyback implantation to correct pseudophakic refractive errors. J Cataract Refract Surg. 2005;31:2101–3.

    Article  PubMed  Google Scholar 

  50. Jin GJ, Crandall AS, Jones JJ. Intraocular lens exchange due to incorrect lens power. Ophthalmology. 2007;114:417–24.

    Article  PubMed  Google Scholar 

  51. Fernandez-Buenaga R, Alio JL, Perez Ardoy AL, et al. Resolving refractive error after cataract surgery: IOL exchange, piggyback lens, or LASIK. J Refract Surg. 2013;29:676–83.

    Article  PubMed  Google Scholar 

  52. Jendritza BB, Knorz MC, Morton S. Wavefront-guided excimer laser vision correction after multifocal IOL implantation. J Refract Surg. 2008;24:274–9.

    PubMed  Google Scholar 

  53. Spalton DJ. Posterior capsular opacification after cataract surgery. Eye (Lond). 1999;13(Pt 3b):489–92.

    Article  Google Scholar 

  54. Allen D, Vasavada A. Cataract and surgery for cataract. BMJ. 2006;333:128–32.

    Article  PubMed Central  PubMed  Google Scholar 

  55. Awasthi N, Guo S, Wagner BJ. Posterior capsular opacification: a problem reduced but not yet eradicated. Arch Ophthalmol. 2009;127:555–62.

    Article  PubMed  Google Scholar 

  56. Javitt JC, Tielsch JM, Canner JK, et al. National outcomes of cataract extraction. Increased risk of retinal complications associated with Nd:YAG laser capsulotomy. The Cataract Patient Outcomes Research Team. Ophthalmology. 1992;99:1487–97.

    Article  CAS  PubMed  Google Scholar 

  57. Findl O, Buehl W, Bauer P, Sycha T. Interventions for preventing posterior capsule opacification. Cochrane Database Syst Rev. 2010;(2):CD003738.

    Google Scholar 

  58. Shah VC, Russo C, Cannon R, et al. Incidence of Nd:YAG capsulotomy after implantation of AcrySof multifocal and monofocal intraocular lenses: a case controlled study. J Refract Surg. 2010;26(8):565–8.

    Article  PubMed  Google Scholar 

  59. Gauthier L, Lafuma A, Laurendeau C, Berdeaux G. Neodymium:YAG laser rates after bilateral implantation of hydrophobic or hydrophilic multifocal intraocular lenses: twenty-four month retrospective comparative study. J Cataract Refract Surg. 2010;36:1195–200.

    Article  PubMed  Google Scholar 

  60. de Vries NE, Nuijts RM. Multifocal intraocular lenses in cataract surgery: literature review of benefits and side effects. J Cataract Refract Surg. 2013;39:268–78.

    Article  PubMed  Google Scholar 

  61. Chiam PJ, Chan JH, Aggarwal RK, Kasaby S. ReSTOR intraocular lens implantation in cataract surgery: quality of vision. J Cataract Refract Surg. 2006;32:1459–63.

    Article  PubMed  Google Scholar 

  62. Haring G, Dick HB, Krummenauer F, et al. Subjective photic phenomena with refractive multifocal and monofocal intraocular lenses. results of a multicenter questionnaire. J Cataract Refract Surg. 2001;27:245–9.

    Article  CAS  PubMed  Google Scholar 

  63. Alfonso JF, Puchades C, Fernandez-Vega L, et al. Contrast sensitivity comparison between AcrySof ReSTOR and Acri.LISA aspheric intraocular lenses. J Refract Surg. 2010;26:471–7.

    Article  PubMed  Google Scholar 

  64. Aychoua N, Junoy Montolio FG, Jansonius NM. Influence of multifocal intraocular lenses on standard automated perimetry test results. JAMA Ophthalmol. 2013;131:481–5.

    Article  PubMed  Google Scholar 

  65. Mesci C, Erbil HH, Olgun A, et al. Differences in contrast sensitivity between monofocal, multifocal and accommodating intraocular lenses: long-term results. Clin Experiment Ophthalmol. 2010;38:768–77.

    Article  PubMed  Google Scholar 

  66. Mesci C, Erbil H, Ozdoker L, et al. Visual acuity and contrast sensitivity function after accommodative and multifocal intraocular lens implantation. Eur J Ophthalmol. 2010;20:90–100.

    PubMed  Google Scholar 

  67. Mester U, Hunold W, Wesendahl T, Kaymak H. Functional outcomes after implantation of Tecnis ZM900 and Array SA40 multifocal intraocular lenses. J Cataract Refract Surg. 2007;33:1033–40.

    Article  PubMed  Google Scholar 

  68. Donnenfeld ED, Solomon R, Roberts CW, et al. Cyclosporine 0.05 % to improve visual outcomes after multifocal intraocular lens implantation. J Cataract Refract Surg. 2010;36:1095–100.

    Article  PubMed  Google Scholar 

  69. Li XM, Hu L, Hu J, Wang W. Investigation of dry eye disease and analysis of the pathogenic factors in patients after cataract surgery. Cornea. 2007;26:S16–20.

    Article  PubMed  Google Scholar 

  70. Ram J, Gupta A, Brar G, et al. Outcomes of phacoemulsification in patients with dry eye. J Cataract Refract Surg. 2002;28:1386–9.

    Article  PubMed  Google Scholar 

  71. Alio JL, Colecha JR, Pastor S, et al. Symptomatic dry eye treatment with autologous platelet-rich plasma. Ophthalmic Res. 2007;39:124–9.

    Article  PubMed  Google Scholar 

  72. Alio JL, Pastor S, Ruiz-Colecha J, et al. Treatment of ocular surface syndrome after LASIK with autologous platelet-rich plasma. J Refract Surg. 2007;23:617–9.

    PubMed  Google Scholar 

  73. Javaloy J, Alio JL, Rodriguez AE, et al. Effect of platelet-rich plasma in nerve regeneration after LASIK. J Refract Surg. 2013;29:213–9.

    PubMed  Google Scholar 

  74. Alio JL, Arnalich-Montiel F, Rodriguez AE. The role of “eye platelet rich plasma” (E-PRP) for wound healing in ophthalmology. Curr Pharm Biotechnol. 2012;13:1257–65.

    Article  CAS  PubMed  Google Scholar 

  75. Alio JL, Rodriguez AE, Martinez LM, Rio AL. Autologous fibrin membrane combined with solid platelet-rich plasma in the management of perforated corneal ulcers: a pilot study. JAMA Ophthalmol. 2013;131:745–51.

    Article  CAS  PubMed  Google Scholar 

  76. Fernandez-Buenaga R, Alio JL, Munoz-Negrete FJ, et al. Causes of IOL explantation in Spain. Eur J Ophthalmol. 2012;22:762–8.

    PubMed  Google Scholar 

  77. Fernandez-Buenaga R, Alio JL, Perez-Ardoy AL, et al. Late in-the-bag intraocular lens dislocation requiring explantation: risk factors and outcomes. Eye (Lond). 2013;27:795–801.

    Article  CAS  Google Scholar 

  78. Fernandez-Buenaga R, Alio JL, Pinilla-Cortes L, Barraquer RI. Perioperative complications and clinical outcomes of intraocular lens exchange in patients with opacified lenses. Graefes Arch Clin Exp Ophthalmol. 2013;251:2141–6.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethical Requirements

Roberto Fernández Buenaga and Jorge L. Alió y Sanz 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.

Author information

Authors and Affiliations

  1. Vissum Corporation, Alicante, Spain

    Roberto Fernández-Buenaga MD, PhD & Jorge L. Alió MD, PhD, FEBO

  2. Anterior Segment Unit, Alicante, Spain

    Roberto Fernández-Buenaga MD, PhD

  3. Division of Ophthalmology, Miguel Hernandez University, Alicante, Spain

    Jorge L. Alió MD, PhD, FEBO

Authors
  1. Roberto Fernández-Buenaga MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jorge L. Alió MD, PhD, FEBO
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jorge L. Alió MD, PhD, FEBO .

Editor information

Editors and Affiliations

  1. Division of Ophthalmology, Miguel Hernandez University, Alicante, Spain

    Jorge L. Alió

  2. Department of Ophthalmology, Ziv Medical Center, Safed, Israel

    Joseph Pikkel

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Fernández-Buenaga, R., Alió, J.L. (2014). Multifocal Intraocular Lenses: Complications. In: Alió, J., Pikkel, J. (eds) Multifocal Intraocular Lenses. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-09219-5_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-09219-5_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-09218-8

  • Online ISBN: 978-3-319-09219-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation