Comparison of Visual and Ocular Hemodynamic Outcomes Following Trifocal vs Bifocal Intraocular Lens Implantation in Patients With Cataract and Myopia.

BACKGROUND This retrospective study from a single center aimed to compare postoperative visual, structural, and ocular hemodynamic outcomes following implantation of a trifocal intraocular lens (IOL) in 67 patients and a bifocal IOL in 67 patients with combined cataract and myopia. MATERIAL AND METHODS A total of 134 patients (268 eyes) with cataract and myopia treated between June 2022 and June 2024 were retrospectively analyzed and divided into a bifocal IOL group (n=67; 134 eyes) and a trifocal IOL group (n=67; 134 eyes). All patients underwent standardized phacoemulsification with capsular bag IOL implantation and were evaluated 6 months postoperatively. Outcomes included visual acuity, intraocular pressure, anterior chamber depth, axial length, lens thickness, mean blood flow density, pulsatility index, and resistance index. Generalized estimating equation models were used to account for inter-eye correlation. RESULTS Compared with the bifocal IOL group, the trifocal IOL group showed lower postoperative intraocular pressure (P=0.003) and anterior chamber depth (P=0.004) and improved oculus dexter visual acuity (P=0.003). Lens thickness was lower postoperatively, whereas axial length remained stable between groups. Mean blood flow density increased (P=0.020), whereas pulsatility index (P=0.003) and resistance index (P=0.002) decreased. Adverse events were less frequent in the trifocal IOL group (P=0.029). However, the observed differences were modest, with uncertain clinical significance. CONCLUSIONS Trifocal IOL implantation was associated with limited postoperative differences in visual and hemodynamic outcomes compared with bifocal IOL implantation. These findings require cautious interpretation and validation in larger prospective studies with longer follow-up.