Rotationally Asymmetric Refractive Low Addition Multifocal IOL Implantation in Patients With Previous Hyperopic Corneal Laser Refractive Surgery

Purpose: To evaluate visual, refractive, and quality-of-vision outcomes after cataract surgery with a low-addition rotationally asymmetric refractive multifocal intraocular lens (Lentis Comfort Mplus LS-313 MF15; Teleon) in eyes with prior hyperopic corneal laser refractive surgery. Methods: This was a retrospective observational study of 26 eyes (26 patients) implanted with the LENTIS Comfort Mplus LS-313 MF15 after uneventful surgery. Distance, intermediate, and near visual acuity, manifest refraction, ocular/corneal wavefront aberrations, contrast sensitivity, and defocus curves were assessed preoperatively and at 1, 3, and 6 months and at the final visit. Subjective quality was measured with the Quality of Vision (QoV) questionnaire. Results: At 6 months and the final visit, uncorrected (UDVA), corrected (CDVA), uncorrected near (UNVA), and corrected near (CNVA) visual acuity improved to 0.10 ± 0.14, 0.05 ± 0.06, 0.27 ± 0.22, and 0.08 ± 0.10 logarithm of the minimum angle of resolution (logMAR), respectively (all P < .05). UIVA and CDIVA were 0.12 ± 0.07 and 0.10 ± 0.09 logMAR, respectively. Refractive cylinder decreased to −0.40 ± 0.38 diopters (D) ( P < .05); mean spherical equivalent at 6 months was 0.00 ± 0.70 D. Ocular root mean square for total, astigmatism, coma, asymmetry, HOAs, spherical-like, and coma-like aberrations were 0.59 ± 0.36, 0.42 ± 0.28, 0.20 ± 0.12, 0.05 ± 0.03, 0.39 ± 0.28, 0.16 ± 0.12, and 0.30 ± 0.20 µm, respectively. Defocus showed 0.05 ± 0.01 logMAR at 0.00 D, 0.13 ± 0.01 at −1.50 D, and 0.27 ± 0.20 at −2.50 D; contrast sensitivity remained within normal limits. QoV scores were 32.97 ± 24.31 (frequency), 30.47 ± 22.19 (severity), and 28.59 ± 21.32 (bothersomeness). Corneal higher order aberrations (HOAs) and angle kappa correlated with postoperative uncorrected acuity, especially at intermediate and near. Conclusions: The aberration-neutral, rotationally asymmetric LENTIS Comfort Mplus LS-313 MF15 provided safe, predictable rehabilitation in eyes after hyperopic corneal surgery, with high-quality distance/intermediate vision and low photic phenomena. Preoperative HOAs and angle kappa significantly influenced postoperative uncorrected vision.