Multifocal IOLs Do Not Preclude Pars Plana Vitrectomy

Conjunctive has started to move back to its original position, so surgeon repositions it, during a pars plana vitrectomy. Close-up (Photo by Universal Images Group via Getty Images)
Patients with epiretinal membranes still saw improvements in their vision at various distances after surgery, even if they had prior trifocal implants.

Multifocal intraocular lenses (IOL) do not preclude the use of pars plana vitrectomy (PPV) for treatment of patients with epiretinal membrane (ERM), according to a retrospective cohort study published in BMC Ophthalmology. The report shows that, even in patients with a trifocal lens, the procedure is a safe and effective method of ERM removal that allows for the recovery of the loss of uncorrected near visual acuity.

Researchers have previously noted reductions in contrast sensitivity with diffractive trifocal IOLs and have recommended avoiding implantation of multifocal IOLs in patients with macular impairments.

The researchers looked at a series of 20 eyes (12 men; 8 women; mean age, 63±3 years) implanted with the same trifocal IOL — the Finevision MicroF® (PhysIOL) for at least 1 year after surgery. They evaluated the patients for any changes to their visual acuities, central macular thicknesses (CMT), spherical equivalent, and recovery of the external retinal layers. 

The participants’ mean uncorrected distance visual acuity (UDVA) after lensectomy was 0.08±0.03 logMAR. The development of ERM decreased that mean UDVA to 0.35±0.13 logMAR. Finally, their UDVA 12 months after PPV was 0.19±0.09 logMAR. Corrected distance visual acuity (CDVA) after lensectomy was 0.03±0.03 logMAR, which dropped to 0.23±0.10 logMAR when ERM was diagnosed, and fell to 0.10±0.04 logMAR at 6 months after PPV.  

Near visual acuities were similarly affected. The mean uncorrected near visual acuity (UNVA) 3 months after lensectomy was Jaeger 2.62±0.51. This UNVA worsened to Jaeger 5.46±1.67 prior to PPV. A year after the procedure, the UNVA improved to Jaeger 2.69±0.84.

These findings demonstrate that patients who had previously received a multifocal IOL implant and later developed ERM were able to achieve significant improvements in CDVA, UDVA, and UNVA after undergoing PPV, the study authors report.

The study is limited by its retrospective design, its use of 3 different imaging devices, and the absence of measurements of contrast sensitivity and metamorphopsia.

“Despite the relatively small sample size of 20 eyes, our results suggest that this trifocal IOL does not affect visual outcomes,” investigators explain.


Arrevola‐Velasco L, Beltran J, Gimeno MJ, et al. Visual outcomes after vitrectomy for epiretinal membrane in pseudophakic eyes with a diffractive trifocal intraocular lens: a retrospective cohort study. BMC Ophthalmol. Published online January 27, 2022. doi:10.1186/s12886-022-02273-6