Evaluating Presbyopia-Correcting IOLs in Complex Cataract Cases With Anterior Segment Abnormalities

Clinical Study on the Application of Presbyopia-correcting Intraocular Lenses in the Surgery of Cataract Patients With Combined Anterior Segment Structural Abnormalities

The goal of cataract surgery has evolved from simply restoring sight to providing clear and comfortable full-range vision. Traditionally, monofocal IOLs remain the routine choice for special cases with anterior segment abnormalities-such as lens subluxation, cataract with chronic uveitis, post-laser refractive cataract, and aphakia with insufficient capsular support. However, there is a growing demand among these patients for improved visual quality and spectacle independence.Currently, various presbyopia-correcting IOLs offer distinct advantages, providing more personalized options. The introduction and application of intraoperative optical coherence tomography (iOCT) ensures effective intraoperative monitoring. These advances make the precise implantation of presbyopia-correcting IOLs a promising extension to phacoemulsification in complex cataracts with anterior segment abnormalities.

Nevertheless, their exact benefits regarding visual quality, safety, and patient satisfaction require systematic evaluation through rigorous prospective studies and long-term follow-up. Under strict perioperative management, this study will employ iOCT to monitor the accurate implantation of presbyopia-correcting IOLs and will assess postoperative visual quality and patient satisfaction.

Study Overview

• Status: Recruiting
• Conditions: Lens Diseases
• Intervention / Treatment: Procedure: Unilateral Posterior Chamber Implantation of Presbyopia-Correcting IOL; Procedure: Unilateral Posterior Chamber Implantation of Monofocal IOL

Detailed Description

With the evolution of refractive cataract surgery, the goal of treatment has progressed from simple visual rehabilitation to providing clear and comfortable full-range vision through the implantation of functional intraocular lenses (IOLs). Traditionally, monofocal IOLs have been the standard choice for patients with anterior segment abnormalities-such as lens subluxation, cataract with a history of chronic anterior uveitis, post-laser refractive surgery cataract, or aphakia with insufficient capsular support-to minimize adverse optical outcomes. However, these patients, who span a broad age range, increasingly desire high postoperative visual quality and reduced spectacle dependence. Modern presbyopia-correcting IOLs offer advantages in material properties, structural design, and optical performance, improving biocompatibility and reducing visual disturbances such as glare and halos, thereby expanding personalized options. The integration of intraoperative optical coherence tomography (iOCT) further enhances the precision and safety of IOL implantation.

Based on these advancements, the precise implantation of presbyopia-correcting IOLs holds promise for complex cataract cases with anterior segment abnormalities. Nevertheless, their efficacy, safety, and impact on patient satisfaction require systematic evaluation through well-designed prospective studies. This prospective study aims to assess the clinical outcomes of precisely implanted presbyopia-correcting IOLs in patients with complex cataract and anterior segment structural abnormalities, including lens subluxation, chronic anterior uveitis, post-refractive surgery status, and aphakia with inadequate capsular support. Utilizing iOCT for real-time monitoring of anterior segment anatomy, capsular stability, and effective lens position (ELP) during surgery, the study will compare visual quality, safety parameters, and patient satisfaction between presbyopia-correcting IOLs and conventional monofocal IOLs, providing evidence to support individualized IOL selection in this population.

• Study Type: Interventional
• Enrollment (Estimated): 320
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Wen Xu, Phd; Phone Number: 86+13858185223; Email: xuwen2003@zju.edu.cn

Study Locations

• China
  • Zhejiang
    • Hangzhou, Zhejiang, China
      • Recruiting
      • Second Affiliated Hospital, Zhejiang University School of Medicine
      • Contact: Wen Xu, Phd; Phone Number: 86+ 13858185223; Email: xuwen2003@zju.edu.cn

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Lens Subluxation Unilateral Implantation Group

   • Patients aged 18-80 years with diagnosed lens subluxation meeting surgical indications for lens surgery, enrolled unilaterally;
   • Informed consent for the study;
   • Ability to comply with full follow-up;
   • Kappa angle <0.5 mm, total higher-order aberration root mean square (HOA RMS) within the central 4-mm corneal zone <1 μm;
   • Mesopic natural pupil diameter between 3.0 mm and 5.5 mm;
   • Expected postoperative astigmatism ≤1.0 D, with target spherical equivalent between 0.00 D and ±0.75 D;
   • Subjective desire to improve full-range visual function.

2. Inactive Long-standing Anterior Uveitis with Cataract Unilateral Implantation Group

   • Patients aged 18-80 years with diagnosed inactive long-standing anterior uveitis (quiet for ≥3 months) and cataract meeting surgical indications for lens surgery, enrolled unilaterally;
   • Centered pupil without significant deformity, with expected postoperative mesopic natural pupil diameter between 2.5 mm and 5.5 mm;
   • Informed consent for the study;
   • Ability to comply with full follow-up;
   • Kappa angle <0.5 mm, total higher-order aberration root mean square (HOA RMS) within the central 4-mm corneal zone <1 μm;
   • Expected postoperative astigmatism ≤1.0 D, with target spherical equivalent between 0.00 D and ±0.75 D;
   • Subjective desire to improve full-range visual function.

3. Post-myopic Laser Corneal Surgery with Cataract Unilateral Implantation Group

   • Patients aged 18-80 years with cataract following prior myopic laser corneal surgery meeting surgical indications for lens surgery, enrolled unilaterally;
   • Informed consent for the study;
   • Ability to comply with full follow-up;
   • Kappa angle <0.5 mm, total higher-order aberration root mean square (HOA RMS) within the central 4-mm corneal zone <1 μm;
   • Mesopic natural pupil diameter between 3.0 mm and 5.5 mm;
   • Expected postoperative astigmatism ≤1.0 D, with target spherical equivalent between 0.00 D and ±0.75 D;
   • Subjective desire to improve full-range visual function.

4. Aphakia with Insufficient Residual Capsular Support Unilateral Implantation Group

   • Patients aged 18-80 years with aphakia and insufficient residual capsular support meeting surgical indications for IOL implantation, enrolled unilaterally;
   • Informed consent for the study;
   • Ability to comply with full follow-up;
   • Kappa angle <0.5 mm, total higher-order aberration root mean square (HOA RMS) within the central 4-mm corneal zone <1 μm;
   • Mesopic natural pupil diameter between 3.0 mm and 5.5 mm;
   • Expected postoperative astigmatism ≤1.0 D, with target spherical equivalent between 0.00 D and ±0.75 D;
   • Subjective desire to improve full-range visual function.

Exclusion Criteria:

1. Lens Subluxation Unilateral Implantation Group

   • Patients with coexisting ocular developmental anomalies such as microphthalmos or microcornea.
   • Patients with severe or progressive ocular diseases (e.g., glaucoma, diabetic retinopathy, macular degeneration) or severe optic nerve disorders.
   • Patients with other organic ocular pathologies, including pathologic high myopia with fundus changes, significant pupillary abnormalities (excessively large or small pupils), severe corneal disease or scarring, high irregular astigmatism, chronic uveitis, or severe amblyopia.
   • Patients with lens disorders other than subluxation and cataract.
   • Patients experiencing intraoperative complications that may affect IOL position and outcome (e.g., posterior capsule rupture, iris prolapse)
   • Patients with a history of prior ocular surgery such as corneal refractive laser surgery, glaucoma surgery, or vitrectomy.

2. Inactive Long-standing Anterior Uveitis with Cataract Unilateral Implantation Group

   • Patients with active systemic autoimmune diseases, or any systemic disease history or medication use known to significantly affect vision.
   • Patients with coexisting ocular developmental anomalies such as microphthalmos or microcornea.
   • Patients with severe or progressive ocular diseases (e.g., glaucoma, diabetic retinopathy, macular degeneration) or severe optic nerve disorders.
   • Patients with other organic ocular pathologies, including pathologic high myopia with fundus changes, severe corneal disease or scarring, high irregular astigmatism, active uveitis, significant abnormalities of the lens capsule or zonules, or severe amblyopia.
   • Patients experiencing intraoperative complications that may affect IOL position and outcome (e.g., posterior capsule rupture, iris prolapse).
   • Patients with a history of prior ocular surgery such as corneal refractive laser surgery, glaucoma surgery, or vitrectomy.

3. Post-myopic Laser Corneal Surgery with Cataract Unilateral Implantation Group

   • Patients with coexisting ocular developmental anomalies such as microphthalmos or microcornea.
   • Patients with severe or progressive ocular diseases (e.g., glaucoma, diabetic retinopathy, macular degeneration) or severe optic nerve disorders.
   • Patients with other organic ocular pathologies, including pathologic high myopia with fundus changes, significant pupillary abnormalities (excessively large or small pupils), severe corneal disease, high irregular astigmatism, chronic uveitis, significant abnormalities of the lens capsule or zonules, or severe amblyopia.
   • Patients experiencing intraoperative complications that may affect IOL position or outcome (e.g., posterior capsule rupture, iris prolapse).
   • Patients with a history of prior ocular surgery such as glaucoma surgery or vitrectomy.

4. Aphakia with Insufficient Residual Capsular Support Unilateral Implantation Group

   • Patients with coexisting ocular developmental anomalies such as microphthalmos or microcornea.
   • Patients with severe or progressive ocular diseases (e.g., glaucoma, diabetic retinopathy, macular degeneration) or severe optic nerve disorders.
   • Patients with other organic ocular pathologies, including pathologic high myopia with fundus changes, significant pupillary abnormalities (excessively large or small pupils), severe corneal disease or scarring, high irregular astigmatism, chronic uveitis, or severe amblyopia.
   • Patients experiencing intraoperative complications that may affect IOL position or outcome (e.g., iris prolapse).
   • Patients with a history of prior ocular surgery such as corneal refractive laser surgery, glaucoma surgery, or posterior vitrectomy.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Unilateral Posterior Chamber Presbyopia-Correcting IOL Implantation Group; This arm includes four cohorts of cataract patients with different types of anterior segment structural abnormalities: the lens subluxation group, the chronic anterior uveitis with cataract group, the post-myopic laser corneal surgery with cataract group, and the aphakia with insufficient capsular support group. Patients in each group will undergo unilateral posterior chamber implantation of a suitable type of presbyopia-correcting IOL based on their individual characteristics.	Procedure: Unilateral Posterior Chamber Implantation of Presbyopia-Correcting IOL; Based on the specific characteristics and needs of each of the four patient groups, a suitable presbyopia-correcting IOL will be selected and precisely implanted unilaterally in the posterior chamber.
Active Comparator: Unilateral Posterior Chamber Monofocal IOL Implantation Group; This arm includes four cohorts of cataract patients with different types of anterior segment structural abnormalities: the lens subluxation group, the chronic anterior uveitis with cataract group, the post-myopic laser corneal surgery with cataract group, and the aphakia with insufficient capsular support group. Patients in each control group will undergo unilateral posterior chamber implantation of a monofocal IOL of the same brand as that used in the experimental group.	Procedure: Unilateral Posterior Chamber Implantation of Monofocal IOL; Each control group will undergo unilateral posterior chamber implantation of the same-brand monofocal IOL as used in the experimental group, following conventional selection criteria.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Uncorrected Distance Visual Acuity (UDVA)	Visual acuity measured at distance（at 5m) without correction.	Preoperatively, and postoperatively at 1 day, 1 week, 1 month, and 3 months.
Effective Lens Position (ELP)	ELP determined by IOLMaster 700, anterior segment optical coherence tomography (AS-OCT), and anterior segment photography.	Baseline, and postoperatively at 1 month, and 3 months
Contrast sensitivity (at 2.5 m)	Uncorrected binocular contrast sensitivity was recorded under mesopic, mesopic with glare, photopic, and photopic with glare conditions at spatial frequencies of 3, 6, 12, and 19 cpd.）	Preoperatively, and postoperatively at 1 week, 1 month, and 3 months
Defocus curve (at 5 m)	Defocus curves were obtained monocularly and binocularly under uncorrected vision with a micro-monovision setup. Acuity was recorded across 13 refractive intervals from +2.00 D to -4.00 D in 0.50 D decrements.	Preoperatively, and postoperatively at 1 month and 3 months
Optical visual quality	Visual symptoms (glare/halos/starburst) assessed via QoV questionnaire	Postoperatively at 1 week, 1 month, and 3 months
Visual Function Assessment	Visual Function Index-14 Chinese Version (VF-14-CN) Questionnaire	Postoperatively at 1 week, 1 month, and 3 months
Best Corrected Visual Acuity (BCVA)	Best Corrected Visual Acuity at distance (at 5m)	Preoperatively, and postoperatively at 1 day, 1 week, 1 month, and 3 months
Uncorrected Intermediate Visual Acuity (UIVA)	Uncorrected visual acuity (UCVA) at intermediate.	Preoperatively, and postoperatively at 1 day, 1 week, 1 month, and 3 months
Uncorrected Near Visual Acuity (UNVA)	Uncorrected visual acuity (UCVA) at near (at 40 cm).	Preoperatively, and postoperatively at 1 day, 1 week, 1 month, and 3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intraocular pressure (IOP)	Intraocular pressure (IOP) measured by non-contact tonometer.(mmHg)	Preoperatively, and postoperatively at 1 day, 1 week, 1 month, and 3 months
Pupil Diameter	Measuring Pupil Diameter	Preoperatively, and postoperatively at 1 day, 1 week, 1 month, and 3 months
Ocular B-scan ultrasound		Preoperatively, and postoperatively at 1 month and 3 months
Dry Eye Assessment	Dry eye assessment via Tear Film Break-Up Time (TFBUT)	Preoperatively, and postoperatively at1 week, 1 month, and 3 months
Fundus assessment	Fundus assessment via fundus photography and macular optical coherence tomography (OCT).	Preoperatively, and postoperatively at 1 week, 1 month, and 3 months
Endothelial cell density	Endothelial cell density（%）	Preoperatively and postoperatively 1 month
Frequency of using glasses	Frequency ratings for the use of corrective glasses at a distance, medium range, and close range.	Postoperatively at 1 week, 1 month, and 3 months

Collaborators and Investigators

• Sponsor: Second Affiliated Hospital, School of Medicine, Zhejiang University
• Investigators: Principal Investigator: Wen Xu, Phd, Second Affiliated Hospital, School of Medicine, Zhejiang University

Study record dates

Study Major Dates

• Study Start (Actual): November 17, 2025
• Primary Completion (Estimated): December 31, 2029
• Study Completion (Estimated): December 31, 2029

Study Registration Dates

• First Submitted: December 7, 2025
• First Submitted That Met QC Criteria: December 22, 2025
• First Posted (Actual): January 7, 2026

Study Record Updates

• Last Update Posted (Actual): January 7, 2026
• Last Update Submitted That Met QC Criteria: December 22, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Eye Diseases; Lens Diseases
• Other Study ID Numbers: 2025-1077

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No