Medium-term visual and refractive outcomes in patients with pseudoexfoliation implanted with a toric or multifocal intraocular lens

Purpose: To report medium-term visual acuity and refractive outcomes of patients with pseudoexfoliation implanted with toric or multifocal intraocular lenses (IOLs). Methods: We retrospectively reviewed patients with pseudoexfoliation who had undergone phacoemulsification between 2016 and 2020 with at least 24 months follow-up. Results: Mean follow-up was 44.17 +/- 14.95 months. Toric IOLs were implanted in 48 eyes: mean uncorrected LogMAR visual acuity one month after surgery was 0.03 +/- 0.09, decreasing to 0.08 +/- 0.11 at the last visit (p=.01). Mean refractive cylinder was -0.12 +/- 0.36 diopters one month after surgery and -0.25 +/- 0.44 diopters at the last follow-up visit, p=.012. Multifocal IOLs were implanted in 42 patients: binocular uncorrected distance visual acuity was -0.02 +/- 0.04 one month after surgery and 0.01 +/- 0.05 at the last visit (p=.004); near acuity was 0.01 +/- 0.03 and 0.04 +/- 0.06 respectively (p=.001). In eyes with pseudoexfoliation, absolute spherical equivalent prediction error was 0.22 +/- 0.20 diopters for toric and 0.21 +/- 0.19 diopters for multifocal IOLs. One month after surgery 68.6% of eyes with toric IOLs and 74.2% of eyes with multifocal IOLs were within +/- 0.25 diopters of target spherical equivalent and 91.6% and 90.5% were within +/- 0.5 diopters, respectively. Spherical equivalent did not change significantly during follow-up for either group. Conclusion: Prediction error in eyes with pseudoexfoliation implanted with toric or multifocal IOLs was low and similar to values reported for normal eyes. Postoperative refractive cylinder with toric IOLs was low, with little change during follow-up. Visual function in patients receiving multifocal IOLs was excellent. Therefore, the implantation of these IOLs in eyes with pseudoexfoliation does not seem to cause medium-term problems.