Comparison of clinical performance between trifocal and bifocal intraocular lenses: A meta-analysis

Zequan Xu, Danmin Cao, Xu Chen, Song Wu, Xin Wang, Qiang Wu, Zequan Xu, Danmin Cao, Xu Chen, Song Wu, Xin Wang, Qiang Wu

Abstract

Purpose: To compare the clinical performance between trifocal and bifocal intraocular lenses in bilateral cataract and/or refractive lens exchange (RLE) surgery.

Methods: A comprehensive literature search of PubMed, EMBASE, Cochrane Controlled Trials Register and Web of Science was performed through October 2016 to identify randomized, controlled trials (RCTs) and comparative cohort studies. The primary outcomes were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), defocus curve, spectacle independence, patient satisfaction and contrast sensitivity. The secondary outcomes were residual sphere, spherical equivalent (SE), cylinder and complications.

Results: Six RCTs and 2 cohort studies including 568 eyes (278 in the trifocal group and 290 in the bifocal group) were identified. There was a statically significant difference between the two groups in UDVA (WMD: -0.03, 95% CI: -0.05 to -0.01, P = 0.005), but the difference (0.03 log MAR) is not clinically significant. Intermediate visual acuity was better in the trifocal IOL group judging from UIVA and defocus curves. There was a statically significant difference between the two groups in residual cylinder (WMD: 0.11, 95% CI: 0.02 to 0.20, P = 0.02), and subgroup AT Lisa tri 839MP trifocal also showed significant better UNVA than bifocal IOLs (WMD: -0.13, 95% CI: -0.17 to -0.08, P<0.00001). However, no significant differences were observed in UNVA (WMD: -0.04, 95% CI: -0.11 to 0.02, P = 0.19), spectacle independence (WMD: 1.27, 95% CI: 0.89 to 18.15, P = 0.07), patient satisfaction (WMD: 4.01, 95% CI: 0.07 to 22.72, P = 0.87), residual sphere (WMD: -0.03, 95% CI: -0.18 to 0.13, P = 0.74), SE (WMD: 0.04, 95% CI: -0.09 to 0.16, P = 0.55) or complications (WMD: 2.08, 95% CI: 0.35 to 12.43, P = 0.42).

Conclusions: Trifocal IOL technology (especially AT Lisa trifocal 839M trifocal) had a clear advantage over bifocal IOLs in intermediate visual acuity, while both trifocal IOLs and bifocal IOLs showed excellent performance in distance visual acuity. AT Lisa trifocal 839M trifocal could provide better uncorrected near visual acuity than bifocal IOLs. However, more evidence is needed to compare their spectacle independence, higher satisfaction rate, and photic phenomena.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow diagram of the literature…
Fig 1. Flow diagram of the literature search in this meta-analysis.
Fig 2. Meta-analysis of postoperative binocular uncorrected…
Fig 2. Meta-analysis of postoperative binocular uncorrected distance visual acuity (UDVA).
SD = standard deviation; CI = confidence interval.
Fig 3. Meta-analysis of postoperative binocular uncorrected…
Fig 3. Meta-analysis of postoperative binocular uncorrected near visual acuity (UNVA).
SD = standard deviation; CI = confidence interval; fine vison = Fine Vision Micro F IOL; lisa = AT Lisa tri 839MP IOL.
Fig 4. Meta-analysis of postoperative spectacle independence,…
Fig 4. Meta-analysis of postoperative spectacle independence, patient satisfaction and complications.
SD = standard deviation; CI = confidence interval.
Fig 5. Meta-analysis of postoperative residual sphere…
Fig 5. Meta-analysis of postoperative residual sphere and spherical equivalent (SE).
SD = standard deviation; CI = confidence interval.
Fig 6. Meta-analysis of postoperative residual cylinder.
Fig 6. Meta-analysis of postoperative residual cylinder.
SD = standard deviation; CI = confidence interval; fine vison = Fine Vision Micro F IOL; lisa = AT Lisa tri 839MP IOL.

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