Hydrophobic Acrylic Trifocal IOL in Post-Laser Refractive Surgery Eyes: Visual Performance, Predictability, and Patient-Reported Outcomes.

PURPOSE: To evaluate clinical and patient-reported outcomes of the Clareon PanOptix (CP) hydrophobic acrylic trifocal IOL in eyes with previous myopic laser refractive surgery (LRS).

METHODS

This single-center, ambispective study included 94 eyes of 47 patients with previous myopic LRS undergoing CP implantation. At 6 months, monocular visual acuity (VA), refraction, and refractive outcomes were assessed. Prediction accuracy was compared using Barrett True-K and Haigis-L with conventional keratometry (CK) or total keratometry (TK) on the IOLMaster 700 and Barrett True-K with CK or TK on the Argos; Argos TK incorporated Pentacam-measured posterior corneal astigmatism. Spectacle dependence, satisfaction, and visual disturbances were assessed. Correlations between preoperative corneal higher-order aberrations (HOAs) and postoperative outcomes were analyzed.

RESULTS

Mean uncorrected VAs were 0.028 ± 0.087 logMAR for distance, 0.177 ± 0.130 logMAR for intermediate, and 0.093 ± 0.137 logMAR for near. The mean postoperative spherical equivalent was -0.142 ± 0.375 D, with 81% of eyes within ±0.50 D of emmetropia. In a retrospective comparison of IOL power calculation methods, Barrett True-K with TK on the IOLMaster 700 yielded the highest observed proportion of eyes within ±0.50 D of the intended target (78.7%). After Holm-Bonferroni correction, preoperative corneal HOA RMS and nonspherical HOA RMS at a 3.0-mm diameter were associated with uncorrected distance VA, whereas corneal HOAs at larger analysis diameters (5.0-6.0 mm) were associated with postoperative visual disturbances. Patients reported high satisfaction (3.09 ± 0.62) and complete spectacle independence for distance and intermediate vision.

CONCLUSIONS

The CP trifocal IOL is an effective option for presbyopia correction in post-myopic LRS eyes meeting predefined preoperative corneal aberration criteria. Refractive predictability depended on device-specific formula-keratometry combinations, with Barrett True-K yielding the highest observed ±0.50 D rates with TK (IOLMaster 700) and with CK (Argos). Corneal HOA analysis at specified measurement diameters may further guide patient selection and counseling.