Purpose: To assess visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes that had previously undergone laser in situ keratomileusis (LASIK) for myopia and to compare them with those recorded after implantation of a monofocal IOL.Retrospective comparative cases series.This study evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), safety, and efficacy after the implantation of two comparable trifocal IOL models and one monofocal IOL model in patients who had previously undergone myopic LASIK. Patients were classified according to the implanted IOL (monofocal or trifocal).A total of 211 eyes from 170 patients received a monofocal IOL, and 211 eyes from 161 patients received a trifocal IOL. At the end of the study, after lensectomy, there was a higher myopic residual spherical equivalent in the monofocal group because some eyes had been targeted for slight myopia to achieve monovision; therefore, UDVA was better in the trifocal group. CDVA was comparable in both groups. As expected, both monocular and binocular UNVA were significantly better in the trifocal group. Although the percentage of eyes that lost >= 1 line of CDVA did not differ between the groups, the safety index was slightly better in the monofocal group.Although implantation of monofocal and trifocal IOLs after myopic LASIK yielded excellent distance visual outcomes, UNVA was significantly better for the trifocal IOL, with a minimally worse safety profile. Trifocal IOLs can be considered after previous LASIK for myopia, with an appropriate patient selection.During the last 30 years, millions of patients have undergone corneal laser vision correction (LVC), encouraged by the excellent refractive and satisfaction outcomes obtained, especially for the treatment of myopia. With aging, many of these patients develop presbyopia or cataract and wish to maintain their spectacle independence. Improvements in surgical techniques and intraocular lens (IOL) designs have achieved that replacing an aged dysfunctional crystalline lens leads to stable and functional uncorrected near, intermediate, and distance visual acuity (UNVA, UIVA, and UDVA). A systematic review of the medical literature,[1] confirmed that bilateral implantation of multifocal (MF) IOLs obtains good results for distance and near visual acuity and improves the independence of glasses compared to monofocal IOLs. However, these IOLs have certain drawbacks as halos and reflections and poorer contrast sensitivity, especially under low lighting conditions, are more frequent than with monofocal IOLs.[2] Initially, previous corneal LVC was considered a relative contraindication for MF IOL implantation[3] for several reasons. First, the LVC corneas were considered multifocal and aberrated after the ablation, with the potential to decrease multifocal IOL visual performance, especially under mesopic conditions. Second, IOL power calculations in these eyes remain challenging, even though sources of biometric errors are well established; and achieving emmetropia is especially important to obtain a spectacle-free vision with MF IOLs. Finally, after MF IOL implantation, patients may require further laser excimer treatment to correct any residual refractive error, and this could be limited in cases with extensive previous LVC or insufficient corneal thickness. As these factors can deteriorate the quality of vision, lens surgery with implantation of a multifocal IOL remains a controversial issue in these patients despite our extensive knowledge of and experience in both corneal and lens surgical techniques.Some studies with small series of cases have shown optimal visual and refractive outcomes with hybrid diffractive-refractive[4-6] and low addition diffractive extended-range of vision (EDOF)[7] IOLs in patients with previous corneal LVC for myopia. Recent clinical studies and systematic reviews have demonstrated the advantages of trifocal IOLs over their predecessor bifocal diffractive IOLs.[8,9] Nowadays, diffractive trifocal IOLs offer the highest rates of spectacle independence outcomes among currently available lenses after cataract and refractive lens exchange (RLE), and trifocal IOLs may currently be the most widely implanted type of IOL for presbyopia correction.[10] Therefore, they could become a very interesting and reliable option for patients with previous myopic LVC.The primary objective of the current study was to evaluate, in a large cohort of patients, visual and refractive outcomes of trifocal IOL implantation in eyes previously treated with LVC for myopia. The secondary goal was to compare these clinical outcomes with those obtained with monofocal IOLs, especially in terms of safety.Purpose: To assess visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes that had previously undergone laser in situ keratomileusis (LASIK) for myopia and to compare them with those recorded after implantation of a monofocal IOL.Retrospective comparative cases series.This study evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), safety, and efficacy after the implantation of two comparable trifocal IOL models and one monofocal IOL model in patients who had previously undergone myopic LASIK. Patients were classified according to the implanted IOL (monofocal or trifocal).A total of 211 eyes from 170 patients received a monofocal IOL, and 211 eyes from 161 patients received a trifocal IOL. At the end of the study, after lensectomy, there was a higher myopic residual spherical equivalent in the monofocal group because some eyes had been targeted for slight myopia to achieve monovision; therefore, UDVA was better in the trifocal group. CDVA was comparable in both groups. As expected, both monocular and binocular UNVA were significantly better in the trifocal group. Although the percentage of eyes that lost >= 1 line of CDVA did not differ between the groups, the safety index was slightly better in the monofocal group.Although implantation of monofocal and trifocal IOLs after myopic LASIK yielded excellent distance visual outcomes, UNVA was significantly better for the trifocal IOL, with a minimally worse safety profile. Trifocal IOLs can be considered after previous LASIK for myopia, with an appropriate patient selection.During the last 30 years, millions of patients have undergone corneal laser vision correction (LVC), encouraged by the excellent refractive and satisfaction outcomes obtained, especially for the treatment of myopia. With aging, many of these patients develop presbyopia or cataract and wish to maintain their spectacle independence. Improvements in surgical techniques and intraocular lens (IOL) designs have achieved that replacing an aged dysfunctional crystalline lens leads to stable and functional uncorrected near, intermediate, and distance visual acuity (UNVA, UIVA, and UDVA). A systematic review of the medical literature,[1] confirmed that bilateral implantation of multifocal (MF) IOLs obtains good results for distance and near visual acuity and improves the independence of glasses compared to monofocal IOLs. However, these IOLs have certain drawbacks as halos and reflections and poorer contrast sensitivity, especially under low lighting conditions, are more frequent than with monofocal IOLs.[2] Initially, previous corneal LVC was considered a relative contraindication for MF IOL implantation[3] for several reasons. First, the LVC corneas were considered multifocal and aberrated after the ablation, with the potential to decrease multifocal IOL visual performance, especially under mesopic conditions. Second, IOL power calculations in these eyes remain challenging, even though sources of biometric errors are well established; and achieving emmetropia is especially important to obtain a spectacle-free vision with MF IOLs. Finally, after MF IOL implantation, patients may require further laser excimer treatment to correct any residual refractive error, and this could be limited in cases with extensive previous LVC or insufficient corneal thickness. As these factors can deteriorate the quality of vision, lens surgery with implantation of a multifocal IOL remains a controversial issue in these patients despite our extensive knowledge of and experience in both corneal and lens surgical techniques.Some studies with small series of cases have shown optimal visual and refractive outcomes with hybrid diffractive-refractive[4-6] and low addition diffractive extended-range of vision (EDOF)[7] IOLs in patients with previous corneal LVC for myopia. Recent clinical studies and systematic reviews have demonstrated the advantages of trifocal IOLs over their predecessor bifocal diffractive IOLs.[8,9] Nowadays, diffractive trifocal IOLs offer the highest rates of spectacle independence outcomes among currently available lenses after cataract and refractive lens exchange (RLE), and trifocal IOLs may currently be the most widely implanted type of IOL for presbyopia correction.[10] Therefore, they could become a very interesting and reliable option for patients with previous myopic LVC.The primary objective of the current study was to evaluate, in a large cohort of patients, visual and refractive outcomes of trifocal IOL implantation in eyes previously treated with LVC for myopia. The secondary goal was to compare these clinical outcomes with those obtained with monofocal IOLs, especially in terms of safety.Purpose: To assess visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes that had previously undergone laser in situ keratomileusis (LASIK) for myopia and to compare them with those recorded after implantation of a monofocal IOL.Retrospective comparative cases series.This study evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), safety, and efficacy after the implantation of two comparable trifocal IOL models and one monofocal IOL model in patients who had previously undergone myopic LASIK. Patients were classified according to the implanted IOL (monofocal or trifocal). A total of 211 eyes from 170 patients received a monofocal IOL, and 211 eyes from 161 patients received a trifocal IOL. At the end of the study, after lensectomy, there was a higher myopic residual spherical equivalent in the monofocal group because some eyes had been targeted for slight myopia to achieve monovision; therefore, UDVA was better in the trifocal group. CDVA was comparable in both groups. As expected, both monocular and binocular UNVA were significantly better in the trifocal group. Although the percentage of eyes that lost >= 1 line of CDVA did not differ between the groups, the safety index was slightly better in the monofocal group.Although implantation of monofocal and trifocal IOLs after myopic LASIK yielded excellent distance visual outcomes, UNVA was significantly better for the trifocal IOL, with a minimally worse safety profile. Trifocal IOLs can be considered after previous LASIK for myopia, with an appropriate patient selection.During the last 30 years, millions of patients have undergone corneal laser vision correction (LVC), encouraged by the excellent refractive and satisfaction outcomes obtained, especially for the treatment of myopia. With aging, many of these patients develop presbyopia or cataract and wish to maintain their spectacle independence. Improvements in surgical techniques and intraocular lens (IOL) designs have achieved that replacing an aged dysfunctional crystalline lens leads to stable and functional uncorrected near, intermediate, and distance visual acuity (UNVA, UIVA, and UDVA). A systematic review of the medical literature,[1] confirmed that bilateral implantation of multifocal (MF) IOLs obtains good results for distance and near visual acuity and improves the independence of glasses compared to monofocal IOLs. However, these IOLs have certain drawbacks as halos and reflections and poorer contrast sensitivity, especially under low lighting conditions, are more frequent than with monofocal IOLs.[2] Initially, previous corneal LVC was considered a relative contraindication for MF IOL implantation[3] for several reasons. First, the LVC corneas were considered multifocal and aberrated after the ablation, with the potential to decrease multifocal IOL visual performance, especially under mesopic conditions. Second, IOL power calculations in these eyes remain challenging, even though sources of biometric errors are well established; and achieving emmetropia is especially important to obtain a spectacle-free vision with MF IOLs. Finally, after MF IOL implantation, patients may require further laser excimer treatment to correct any residual refractive error, and this could be limited in cases with extensive previous LVC or insufficient corneal thickness. As these factors can deteriorate the quality of vision, lens surgery with implantation of a multifocal IOL remains a controversial issue in these patients despite our extensive knowledge of and experience in both corneal and lens surgical techniques.Some studies with small series of cases have shown optimal visual and refractive outcomes with hybrid diffractive-refractive[4-6] and low addition diffractive extended-range of vision (EDOF)[7] IOLs in patients with previous corneal LVC for myopia. Recent clinical studies and systematic reviews have demonstrated the advantages of trifocal IOLs over their predecessor bifocal diffractive IOLs. [8,9] Nowadays, diffractive trifocal IOLs offer the highest rates of spectacle independence outcomes among currently available lenses after cataract and refractive lens exchange (RLE), and trifocal IOLs may currently be the most widely implanted type of IOL for presbyopia correction.[10] Therefore, they could become a very interesting and reliable option for patients with previous myopic LVC.The primary objective of the current study was to evaluate, in a large cohort of patients, visual and refractive outcomes of trifocal IOL implantation in eyes previously treated with LVC for myopia. The secondary goal was to compare these clinical outcomes with those obtained with monofocal IOLs, especially in terms of safety.Purpose: To assess visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes that had previously undergone laser in situ keratomileusis (LASIK) for myopia and to compare them with those recorded after implantation of a monofocal IOL.Retrospective comparative cases series.This study evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), safety, and efficacy after the implantation of two comparable trifocal IOL models and one monofocal IOL model in patients who had previously undergone myopic LASIK. Patients were classified according to the implanted IOL (monofocal or trifocal).A total of 211 eyes from 170 patients received a monofocal IOL, and 211 eyes from 161 patients received a trifocal IOL. At the end of the study, after lensectomy, there was a higher myopic residual spherical equivalent in the monofocal group because some eyes had been targeted for slight myopia to achieve monovision; therefore, UDVA was better in the trifocal group. CDVA was comparable in both groups. As expected, both monocular and binocular UNVA were significantly better in the trifocal group. Although the percentage of eyes that lost >= 1 line of CDVA did not differ between the groups, the safety index was slightly better in the monofocal group.Although implantation of monofocal and trifocal IOLs after myopic LASIK yielded excellent distance visual outcomes, UNVA was significantly better for the trifocal IOL, with a minimally worse safety profile. Trifocal IOLs can be considered after previous LASIK for myopia, with an appropriate patient selection.During the last 30 years, millions of patients have undergone corneal laser vision correction (LVC), encouraged by the excellent refractive and satisfaction outcomes obtained, especially for the treatment of myopia. With aging, many of these patients develop presbyopia or cataract and wish to maintain their spectacle independence. Improvements in surgical techniques and intraocular lens (IOL) designs have achieved that replacing an aged dysfunctional crystalline lens leads to stable and functional uncorrected near, intermediate, and distance visual acuity (UNVA, UIVA, and UDVA). A systematic review of the medical literature,[1] confirmed that bilateral implantation of multifocal (MF) IOLs obtains good results for distance and near visual acuity and improves the independence of glasses compared to monofocal IOLs. However, these IOLs have certain drawbacks as halos and reflections and poorer contrast sensitivity, especially under low lighting conditions, are more frequent than with monofocal IOLs.[2] Initially, previous corneal LVC was considered a relative contraindication for MF IOL implantation[3] for several reasons. First, the LVC corneas were considered multifocal and aberrated after the ablation, with the potential to decrease multifocal IOL visual performance, especially under mesopic conditions. Second, IOL power calculations in these eyes remain challenging, even though sources of biometric errors are well established; and achieving emmetropia is especially important to obtain a spectacle-free vision with MF IOLs. Finally, after MF IOL implantation, patients may require further laser excimer treatment to correct any residual refractive error, and this could be limited in cases with extensive previous LVC or insufficient corneal thickness. As these factors can deteriorate the quality of vision, lens surgery with implantation of a multifocal IOL remains a controversial issue in these patients despite our extensive knowledge of and experience in both corneal and lens surgical techniques.Some studies with small series of cases have shown optimal visual and refractive outcomes with hybrid diffractive-refractive[4-6] and low addition diffractive extended-range of vision (EDOF)[7] IOLs in patients with previous corneal LVC for myopia. Recent clinical studies and systematic reviews have demonstrated the advantages of trifocal IOLs over their predecessor bifocal diffractive IOLs.[8,9] Nowadays, diffractive trifocal IOLs offer the highest rates of spectacle independence outcomes among currently available lenses after cataract and refractive lens exchange (RLE), and trifocal IOLs may currently be the most widely implanted type of IOL for presbyopia correction.[10] Therefore, they could become a very interesting and reliable option for patients with previous myopic LVC.The primary objective of the current study was to evaluate, in a large cohort of patients, visual and refractive outcomes of trifocal IOL implantation in eyes previously treated with LVC for myopia. The secondary goal was to compare these clinical outcomes with those obtained with monofocal IOLs, especially in terms of safety.Purpose: To assess visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes that had previously undergone laser in situ keratomileusis (LASIK) for myopia and to compare them with those recorded after implantation of a monofocal IOL.Retrospective comparative cases series.This study evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), safety, and efficacy after the implantation of two comparable trifocal IOL models and one monofocal IOL model in patients who had previously undergone myopic LASIK. Patients were classified according to the implanted IOL (monofocal or trifocal).A total of 211 eyes from 170 patients received a monofocal IOL, and 211 eyes from 161 patients received a trifocal IOL. At the end of the study, after lensectomy, there was a higher myopic residual spherical equivalent in the monofocal group because some eyes had been targeted for slight myopia to achieve monovision; therefore, UDVA was better in the trifocal group. CDVA was comparable in both groups. As expected, both monocular and binocular UNVA were significantly better in the trifocal group. Although the percentage of eyes that lost >= 1 line of CDVA did not differ between the groups, the safety index was slightly better in the monofocal group.Although implantation of monofocal and trifocal IOLs after myopic LASIK yielded excellent distance visual outcomes, UNVA was significantly better for the trifocal IOL, with a minimally worse safety profile. Trifocal IOLs can be considered after previous LASIK for myopia, with an appropriate patient selection.During the last 30 years, millions of patients have undergone corneal laser vision correction (LVC), encouraged by the excellent refractive and satisfaction outcomes obtained, especially for the treatment of myopia. With aging, many of these patients develop presbyopia or cataract and wish to maintain their spectacle independence. Improvements in surgical techniques and intraocular lens (IOL) designs have achieved that replacing an aged dysfunctional crystalline lens leads to stable and functional uncorrected near, intermediate, and distance visual acuity (UNVA, UIVA, and UDVA). A systematic review of the medical literature,[1] confirmed that bilateral implantation of multifocal (MF) IOLs obtains good results for distance and near visual acuity and improves the independence of glasses compared to monofocal IOLs. However, these IOLs have certain drawbacks as halos and reflections and poorer contrast sensitivity, especially under low lighting conditions, are more frequent than with monofocal IOLs.[2] Initially, previous corneal LVC was considered a relative contraindication for MF IOL implantation[3] for several reasons. First, the LVC corneas were considered multifocal and aberrated after the ablation, with the potential to decrease multifocal IOL visual performance, especially under mesopic conditions. Second, IOL power calculations in these eyes remain challenging, even though sources of biometric errors are well established; and achieving emmetropia is especially important to obtain a spectacle-free vision with MF IOLs. Finally, after MF IOL implantation, patients may require further laser excimer treatment to correct any residual refractive error, and this could be limited in cases with extensive previous LVC or insufficient corneal thickness. As these factors can deteriorate the quality of vision, lens surgery with implantation of a multifocal IOL remains a controversial issue in these patients despite our extensive knowledge of and experience in both corneal and lens surgical techniques.Some studies with small series of cases have shown optimal visual and refractive outcomes with hybrid diffractive-refractive[4-6] and low addition diffractive extended-range of vision (EDOF)[7] IOLs in patients with previous corneal LVC for myopia. Recent clinical studies and systematic reviews have demonstrated the advantages of trifocal IOLs over their predecessor bifocal diffractive IOLs.[8,9] Nowadays, diffractive trifocal IOLs offer the highest rates of spectacle independence outcomes among currently available lenses after cataract and refractive lens exchange (RLE), and trifocal IOLs may currently be the most widely implanted type of IOL for presbyopia correction.[10] Therefore, they could become a very interesting and reliable option for patients with previous myopic LVC.The primary objective of the current study was to evaluate, in a large cohort of patients, visual and refractive outcomes of trifocal IOL implantation in eyes previously treated with LVC for myopia. The secondary goal was to compare these clinical outcomes with those obtained with monofocal IOLs, especially in terms of safety.Purpose: To assess visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes that had previously undergone laser in situ keratomileusis (LASIK) for myopia and to compare them with those recorded after implantation of a monofocal IOL.Retrospective comparative cases series. This study evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), safety, and efficacy after the implantation of two comparable trifocal IOL models and one monofocal IOL model in patients who had previously undergone myopic LASIK. Patients were classified according to the implanted IOL (monofocal or trifocal).A total of 211 eyes from 170 patients received a monofocal IOL, and 211 eyes from 161 patients received a trifocal IOL. At the end of the study, after lensectomy, there was a higher myopic residual spherical equivalent in the monofocal group because some eyes had been targeted for slight myopia to achieve monovision; therefore, UDVA was better in the trifocal group. CDVA was comparable in both groups. As expected, both monocular and binocular UNVA were significantly better in the trifocal group. Although the percentage of eyes that lost >= 1 line of CDVA did not differ between the groups, the safety index was slightly better in the monofocal group.Although implantation of monofocal and trifocal IOLs after myopic LASIK yielded excellent distance visual outcomes, UNVA was significantly better for the trifocal IOL, with a minimally worse safety profile. Trifocal IOLs can be considered after previous LASIK for myopia, with an appropriate patient selection.During the last 30 years, millions of patients have undergone corneal laser vision correction (LVC), encouraged by the excellent refractive and satisfaction outcomes obtained, especially for the treatment of myopia. With aging, many of these patients develop presbyopia or cataract and wish to maintain their spectacle independence. Improvements in surgical techniques and intraocular lens (IOL) designs have achieved that replacing an aged dysfunctional crystalline lens leads to stable and functional uncorrected near, intermediate, and distance visual acuity (UNVA, UIVA, and UDVA). A systematic review of the medical literature,[1] confirmed that bilateral implantation of multifocal (MF) IOLs obtains good results for distance and near visual acuity and improves the independence of glasses compared to monofocal IOLs. However, these IOLs have certain drawbacks as halos and reflections and poorer contrast sensitivity, especially under low lighting conditions, are more frequent than with monofocal IOLs.[2] Initially, previous corneal LVC was considered a relative contraindication for MF IOL implantation[3] for several reasons. First, the LVC corneas were considered multifocal and aberrated after the ablation, with the potential to decrease multifocal IOL visual performance, especially under mesopic conditions. Second, IOL power calculations in these eyes remain challenging, even though sources of biometric errors are well established; and achieving emmetropia is especially important to obtain a spectacle-free vision with MF IOLs. Finally, after MF IOL implantation, patients may require further laser excimer treatment to correct any residual refractive error, and this could be limited in cases with extensive previous LVC or insufficient corneal thickness. As these factors can deteriorate the quality of vision, lens surgery with implantation of a multifocal IOL remains a controversial issue in these patients despite our extensive knowledge of and experience in both corneal and lens surgical techniques. Some studies with small series of cases have shown optimal visual and refractive outcomes with hybrid diffractive-refractive[4-6] and low addition diffractive extended-range of vision (EDOF)[7] IOLs in patients with previous corneal LVC for myopia. Recent clinical studies and systematic reviews have demonstrated the advantages of trifocal IOLs over their predecessor bifocal diffractive IOLs.[8,9] Nowadays, diffractive trifocal IOLs offer the highest rates of spectacle independence outcomes among currently available lenses after cataract and refractive lens exchange (RLE), and trifocal IOLs may currently be the most widely implanted type of IOL for presbyopia correction.[10] Therefore, they could become a very interesting and reliable option for patients with previous myopic LVC.The primary objective of the current study was to evaluate, in a large cohort of patients, visual and refractive outcomes of trifocal IOL implantation in eyes previously treated with LVC for myopia. The secondary goal was to compare these clinical outcomes with those obtained with monofocal IOLs, especially in terms of safety.Purpose: To assess visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes that had previously undergone laser in situ keratomileusis (LASIK) for myopia and to compare them with those recorded after implantation of a monofocal IOL.Retrospective comparative cases series.This study evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), safety, and efficacy after the implantation of two comparable trifocal IOL models and one monofocal IOL model in patients who had previously undergone myopic LASIK. Patients were classified according to the implanted IOL (monofocal or trifocal).A total of 211 eyes from 170 patients received a monofocal IOL, and 211 eyes from 161 patients received a trifocal IOL. At the end of the study, after lensectomy, there was a higher myopic residual spherical equivalent in the monofocal group because some eyes had been targeted for slight myopia to achieve monovision; therefore, UDVA was better in the trifocal group. CDVA was comparable in both groups. As expected, both monocular and binocular UNVA were significantly better in the trifocal group. Although the percentage of eyes that lost >= 1 line of CDVA did not differ between the groups, the safety index was slightly better in the monofocal group.Although implantation of monofocal and trifocal IOLs after myopic LASIK yielded excellent distance visual outcomes, UNVA was significantly better for the trifocal IOL, with a minimally worse safety profile. Trifocal IOLs can be considered after previous LASIK for myopia, with an appropriate patient selection.During the last 30 years, millions of patients have undergone corneal laser vision correction (LVC), encouraged by the excellent refractive and satisfaction outcomes obtained, especially for the treatment of myopia. With aging, many of these patients develop presbyopia or cataract and wish to maintain their spectacle independence. Improvements in surgical techniques and intraocular lens (IOL) designs have achieved that replacing an aged dysfunctional crystalline lens leads to stable and functional uncorrected near, intermediate, and distance visual acuity (UNVA, UIVA, and UDVA). A systematic review of the medical literature,[1] confirmed that bilateral implantation of multifocal (MF) IOLs obtains good results for distance and near visual acuity and improves the independence of glasses compared to monofocal IOLs. However, these IOLs have certain drawbacks as halos and reflections and poorer contrast sensitivity, especially under low lighting conditions, are more frequent than with monofocal IOLs.[2] Initially, previous corneal LVC was considered a relative contraindication for MF IOL implantation[3] for several reasons. First, the LVC corneas were considered multifocal and aberrated after the ablation, with the potential to decrease multifocal IOL visual performance, especially under mesopic conditions. Second, IOL power calculations in these eyes remain challenging, even though sources of biometric errors are well established; and achieving emmetropia is especially important to obtain a spectacle-free vision with MF IOLs. Finally, after MF IOL implantation, patients may require further laser excimer treatment to correct any residual refractive error, and this could be limited in cases with extensive previous LVC or insufficient corneal thickness. As these factors can deteriorate the quality of vision, lens surgery with implantation of a multifocal IOL remains a controversial issue in these patients despite our extensive knowledge of and experience in both corneal and lens surgical techniques.Some studies with small series of cases have shown optimal visual and refractive outcomes with hybrid diffractive-refractive[4-6] and low addition diffractive extended-range of vision (EDOF)[7] IOLs in patients with previous corneal LVC for myopia. Recent clinical studies and systematic reviews have demonstrated the advantages of trifocal IOLs over their predecessor bifocal diffractive IOLs.[8,9] Nowadays, diffractive trifocal IOLs offer the highest rates of spectacle independence outcomes among currently available lenses after cataract and refractive lens exchange (RLE), and trifocal IOLs may currently be the most widely implanted type of IOL for presbyopia correction.[10] Therefore, they could become a very interesting and reliable option for patients with previous myopic LVC.The primary objective of the current study was to evaluate, in a large cohort of patients, visual and refractive outcomes of trifocal IOL implantation in eyes previously treated with LVC for myopia. The secondary goal was to compare these clinical outcomes with those obtained with monofocal IOLs, especially in terms of safety.Purpose: To assess visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes that had previously undergone laser in situ keratomileusis (LASIK) for myopia and to compare them with those recorded after implantation of a monofocal IOL.Retrospective comparative cases series.This study evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), safety, and efficacy after the implantation of two comparable trifocal IOL models and one monofocal IOL model in patients who had previously undergone myopic LASIK. Patients were classified according to the implanted IOL (monofocal or trifocal).A total of 211 eyes from 170 patients received a monofocal IOL, and 211 eyes from 161 patients received a trifocal IOL. At the end of the study, after lensectomy, there was a higher myopic residual spherical equivalent in the monofocal group because some eyes had been targeted for slight myopia to achieve monovision; therefore, UDVA was better in the trifocal group. CDVA was comparable in both groups. As expected, both monocular and binocular UNVA were significantly better in the trifocal group. Although the percentage of eyes that lost >= 1 line of CDVA did not differ between the groups, the safety index was slightly better in the monofocal group.Although implantation of monofocal and trifocal IOLs after myopic LASIK yielded excellent distance visual outcomes, UNVA was significantly better for the trifocal IOL, with a minimally worse safety profile. Trifocal IOLs can be considered after previous LASIK for myopia, with an appropriate patient selection.During the last 30 years, millions of patients have undergone corneal laser vision correction (LVC), encouraged by the excellent refractive and satisfaction outcomes obtained, especially for the treatment of myopia. With aging, many of these patients develop presbyopia or cataract and wish to maintain their spectacle independence. Improvements in surgical techniques and intraocular lens (IOL) designs have achieved that replacing an aged dysfunctional crystalline lens leads to stable and functional uncorrected near, intermediate, and distance visual acuity (UNVA, UIVA, and UDVA). A systematic review of the medical literature,[1] confirmed that bilateral implantation of multifocal (MF) IOLs obtains good results for distance and near visual acuity and improves the independence of glasses compared to monofocal IOLs. However, these IOLs have certain drawbacks as halos and reflections and poorer contrast sensitivity, especially under low lighting conditions, are more frequent than with monofocal IOLs.[2] Initially, previous corneal LVC was considered a relative contraindication for MF IOL implantation[3] for several reasons. First, the LVC corneas were considered multifocal and aberrated after the ablation, with the potential to decrease multifocal IOL visual performance, especially under mesopic conditions. Second, IOL power calculations in these eyes remain challenging, even though sources of biometric errors are well established; and achieving emmetropia is especially important to obtain a spectacle-free vision with MF IOLs. Finally, after MF IOL implantation, patients may require further laser excimer treatment to correct any residual refractive error, and this could be limited in cases with extensive previous LVC or insufficient corneal thickness. As these factors can deteriorate the quality of vision, lens surgery with implantation of a multifocal IOL remains a controversial issue in these patients despite our extensive knowledge of and experience in both corneal and lens surgical techniques.Some studies with small series of cases have shown optimal visual and refractive outcomes with hybrid diffractive-refractive[4-6] and low addition diffractive extended-range of vision (EDOF)[7] IOLs in patients with previous corneal LVC for myopia. Recent clinical studies and systematic reviews have demonstrated the advantages of trifocal IOLs over their predecessor bifocal diffractive IOLs.[8,9] Nowadays, diffractive trifocal IOLs offer the highest rates of spectacle independence outcomes among currently available lenses after cataract and refractive lens exchange (RLE), and trifocal IOLs may currently be the most widely implanted type of IOL for presbyopia correction.[10] Therefore, they could become a very interesting and reliable option for patients with previous myopic LVC.The primary objective of the current study was to evaluate, in a large cohort of patients, visual and refractive outcomes of trifocal IOL implantation in eyes previously treated with LVC for myopia. The secondary goal was to compare these clinical outcomes with those obtained with monofocal IOLs, especially in terms of safety.
