Selective wavefront-guided corneal ablation for correction of aberrations after implantation of a trifocal intraocular lens

Background A substantially improved wavefront sensor (Peramis, Schwind Eye-Tech Solutions, Kleinostheim, Germany) enables selective wavefront-guided correction of aberrations. This study investigates the potential of selective wavefront-guided ablation to increase the satisfaction level after trifocal intraocular lens (IOL) implantation. Methods Out of 216 eyes from 110 patients who underwent cataract surgery with implantation of multifocal IOLs (FineVision, Physiol, Liege, Belgium), 42 patients were dissatisfied with the postoperative results in 56 eyes (26%). In these 56 eyes a selective wavefront-guided laser in situ keratomileusis (LASIK, Amaris 1050, Schwind Eye-Tech Solutions) was performed. All aberrations apart from 1st and 2nd order spherical aberrations were corrected to compensate ametropia but preserve the apodization of the trifocal IOL and, therefore, preserve the full the multifocal effect. The refractive status and patient satisfaction were documented pre- and postoperatively and statistically compared. Results After implantation of a trifocal IOL 26% were dissatisfied with the postoperative result. The reasons were residual astigmatism of more than 0.5 & x202f;dpt in 63% of the eyes, followed by myopia in 45%, hyperopia in 20% and higher order aberrations in 13%. After selective wavefront-guided LASIK the target refraction of +/- 0.5 & x202f;dpt could be achieved in 98% of the eyes and astigmatism could be reduced to 0.5 & x202f;dpt or less in 93% of the eyes. The level of satisfaction increased from 2.1 & x202f;+/- 0.8 preoperatively to 3.6 & x202f;+/- 0.8 (out of 4) postoperatively. Of the previously dissatisfied patients, 90% would undergo the operation (trifocal IOL and LASIK) again. Conclusion Selective wavefront-guided LASIK reduces refractive errors and increases significantly the acceptance and satisfaction of multifocal IOLs.