International Ophthalmology

, Volume 39, Issue 12, pp 2875–2882 | Cite as

Presbyopic lens exchange (PRELEX) cataract surgery outcomes with implantation of a rotationally asymmetric refractive multifocal intraocular lens: femtosecond laser-assisted versus manual phacoemulsification

  • Peter ŽiakEmail author
  • Juraj Halička
  • Peter Mojžiš
  • Karolína Kapitánová
  • Javorka Michal
  • David P. PiñeroEmail author
Original Paper



To compare the visual and refractive outcomes obtained with the implantation of a rotationally asymmetric refractive multifocal IOL after femtosecond laser-assisted cataract surgery (FLACS) and conventional lens extraction (CLE).


A total of 78 eyes of 58 patients that had undergone conventional phacoemulsification (36 eyes, CLE group) or FLACS (37 eyes, FLACS group) with the implantation of the toric multifocal IOL LU-313 MF30T (Oculentis, Germany) were enrolled in this retrospective study. Mean age was 57.0 years at the time of surgery, ranging from 44 to 69 years. Visual and refractive outcomes were evaluated during a 12-month follow-up. Likewise, contrast sensitivity was assessed at the end of the follow-up.


Significant improvements were observed in both groups in uncorrected distance (UDVA) and near visual acuity (UNVA) at 1 month postoperatively (p < 0.001). Differences between groups in these parameters as well as in sphere and cylinder did not reach statistical significance during the whole follow-up (p ≥ 0.079), except for UNVA only at 12 months postoperatively (p = 0.018). Concerning corrected near visual acuity, only significant differences between groups were found preoperatively (p = 0.020). Furthermore, only a minimal but significant difference between groups was found at 12 months postoperatively in contrast sensitivity for the spatial frequency of 18 cycles/° (p = 0.029).


The rotationally asymmetric toric multifocal IOL LU-313 MF 30T provides good visual rehabilitation for near and distance vision after presbyopic lens extraction in eyes with preexisting astigmatism, independently whether the cataract surgery is performed with the FLACS or conventional technique.


Presbyopia Refractive lens extraction Clear lens extraction Phacoemulsification Femtosecond laser-assisted cataract surgery Multifocal intraocular lens Rotationally asymmetric multifocal intraocular lens 



The author David P. Piñero has been supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal, RYC-2016-20471. The rest of the authors have no received funding for performing this research.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Rosen E, Alió JL, Dick HB, Dell S, Slade S (2016) Efficacy and safety of multifocal intraocular lenses following cataract and refractive lens exchange: metaanalysis of peer-reviewed publications. J Cataract Refract Surg 42:310–328CrossRefGoogle Scholar
  2. 2.
    Alió JL, Grzybowski A, Romaniuk D (2014) Refractive lens exchange in modern practice: When and when not to do it? Eye Vis (Lond) 1:10CrossRefGoogle Scholar
  3. 3.
    Montés-Micó R, López-Gil N, Pérez-Vives C, Bonaque S, Ferrer-Blasco T (2012) In vitro optical performance of nonrotational symmetric and refractive–diffractive aspheric multifocal intraocular lenses: impact of tilt and decentration. J Cataract Refract Surg 38:1657–1663CrossRefGoogle Scholar
  4. 4.
    Linz K, Attia MS, Khoramnia R, Tandogan T, Kretz FT, Auffarth GU (2016) Clinical evaluation of reading performance using the Salzburg Reading Desk with a refractive rotational asymmetric multifocal intraocular lens. J Refract Surg 32:526–532CrossRefGoogle Scholar
  5. 5.
    Venter JA, Pelouskova M, Bull CE, Schallhorn SC, Hannan SJ (2015) Visual outcomes and patient satisfaction with a rotational asymmetric refractive intraocular lens for emmetropic presbyopia. J Cataract Refract Surg 41:585–593CrossRefGoogle Scholar
  6. 6.
    Berrow EJ, Wolffsohn JS, Bilkhu PS, Dhallu S (2014) Visual performance of a new bi-aspheric, segmented, asymmetric multifocal IOL. J Refract Surg 30:584–588CrossRefGoogle Scholar
  7. 7.
    Venter JA, Pelouskova M, Collins BM, Schallhorn SC, Hannan SJ (2013) Visual outcomes and patient satisfaction in 9366 eyes using a refractive segmented multifocal intraocular lens. J Cataract Refract Surg 39:1477–1484CrossRefGoogle Scholar
  8. 8.
    Venter J, Pelouskova M (2013) Outcomes and complications of a multifocal toric intraocular lens with a surface-embedded near section. J Cataract Refract Surg 39:859–866CrossRefGoogle Scholar
  9. 9.
    Alió JL, Plaza-Puche AB, Piñero DP (2012) Rotationally asymmetric multifocal IOL implantation with and without capsular tension ring: refractive and visual outcomes and intraocular optical performance. J Refract Surg 28:253–258CrossRefGoogle Scholar
  10. 10.
    Ramón ML, Piñero DP, Pérez-Cambrodí RJ (2012) Correlation of visual performance with quality of life and intraocular aberrometric profile in patients implanted with rotationally asymmetric multifocal IOLs. J Refract Surg 28:93–99CrossRefGoogle Scholar
  11. 11.
    Muñoz G, Albarrán-Diego C, Ferrer-Blasco T, Sakla HF, García-Lázaro S (2011) Visual function after bilateral implantation of a new zonal refractive aspheric multifocal intraocular lens. J Cataract Refract Surg 37:2043–2052CrossRefGoogle Scholar
  12. 12.
    Alió JL, Piñero DP, Plaza-Puche AB, Chan MJ (2011) Visual outcomes and optical performance of a monofocal intraocular lens and a new-generation multifocal intraocular lens. J Cataract Refract Surg 37:241–250CrossRefGoogle Scholar
  13. 13.
    McAlinden C, Moore JE (2011) Multifocal intraocular lens with a surface-embedded near section: short-term clinical outcomes. J Cataract Refract Surg 37:441–445CrossRefGoogle Scholar
  14. 14.
    Kelman CD (1967) Phacoemulsification and aspiration. A new technique of cataract removal. A preliminary report. Am J Ophthalmol 64:23–35CrossRefGoogle Scholar
  15. 15.
    Grewal DS, Schultz T, Basti S, Dick HB (2016) Femtosecond laser-assisted cataract surgery-current status and future directions. Surv Ophthalmol 61:103–131CrossRefGoogle Scholar
  16. 16.
    Szigeti A, Kránitz K, Takacs AI, Miháltz K, Knorz MC, Nagy ZZ (2012) Comparison of long-term visual outcome and IOL position with a single-optic accommodating IOL after 5.5- or 6.0-mm femtosecond laser capsulotomy. J Refract Surg 28:609–613CrossRefGoogle Scholar
  17. 17.
    Lawless M, Bali SJ, Hodge C, Roberts TV, Chan C, Sutton G (2012) Outcomes of femtosecond laser cataract surgery with a diffractive multifocal intraocular lens. J Refract Surg 28:859–864CrossRefGoogle Scholar
  18. 18.
    Dyrda A, Martínez-Palmer A, Martín-Moral D, Rey A, Morilla A, Castilla-Martí M, Aronés-Santivañez J (2018) Clinical results of diffractive, refractive, hybrid multifocal, and monofocal intraocular lenses. J Ophthalmol 2018:8285637PubMedPubMedCentralGoogle Scholar
  19. 19.
    Fernández J, Rodríguez-Vallejo M, Martínez J, Tauste A, Piñero DP (2018) Biometric factors associated with the visual performance of a high addition multifocal intraocular lens. Curr Eye Res 43:998–1005CrossRefGoogle Scholar
  20. 20.
    Cochener B, Boutillier G, Lamard M, Auberger-Zagnoli C (2018) A comparative evaluation of a new generation of diffractive trifocal and extended depth of focus intraocular lenses. J Refract Surg 34:507–514CrossRefGoogle Scholar
  21. 21.
    Mojzis P, Kukuckova L, Majerova K, Ziak P, Piñero DP (2017) Postoperative visual performance with a bifocal and trifocal diffractive intraocular lens during a 1-year follow-up. Int J Ophthalmol 10:1528–1533PubMedPubMedCentralGoogle Scholar
  22. 22.
    Mojzis P, Majerova K, Hrckova L, Piñero DP (2015) Implantation of a diffractive trifocal intraocular lens: one-year follow-up. J Cataract Refract Surg 41:1623–1630CrossRefGoogle Scholar
  23. 23.
    Conrad-Hengerer I, Al Juburi M, Schultz T, Hengerer FH, Dick HB (2013) Corneal endothelial cell loss and corneal thickness in conventional compared with femtosecond laser-assisted cataract surgery: three-month follow-up. J Cataract Refract Surg 39:1307–1313CrossRefGoogle Scholar
  24. 24.
    Abell RG, Kerr NM, Vote BJ (2013) Toward zero effective phacoemulsification time using femtosecond laser pretreatment. Ophthalmology 120:942–948CrossRefGoogle Scholar
  25. 25.
    Abell RG, Kerr NM, Howie AR, Mustaffa Kamal MA, Allen PL, Vote BJ (2014) Effect of femtosecond laser-assisted cataract surgery on the corneal endothelium. J Cataract Refract Surg 40:1777–1783CrossRefGoogle Scholar
  26. 26.
    Kranitz K, Miháltz K, Sándor GL, Takacs A, Knorz MC, Nagy ZZ (2012) Intraocular lens tilt and decentration measured by Scheimpflug camera following manual or femtosecond laser-created continuous circular capsulotomy. J Refract Surg 28:259–263CrossRefGoogle Scholar
  27. 27.
    Popovic M, Campos-Möller X, Schlenker MB, Ahmed II (2016) Efficacy and safety of femtosecond laser-assisted cataract surgery compared with manual cataract surgery: a meta-analysis of 14567 eyes. Ophthalmology 123:2113–2126CrossRefGoogle Scholar
  28. 28.
    Ewe SY, Abell RG, Vote BJ (2018) Femtosecond laser-assisted versus phacoemulsification for cataract extraction and intraocular lens implantation: clinical outcomes review. Curr Opin Ophthalmol 29:54–60CrossRefGoogle Scholar
  29. 29.
    Chen X, Chen K, He J, Yao K (2016) Comparing the curative effects between femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery: a meta-analysis. PLoS ONE 11:e0152088CrossRefGoogle Scholar
  30. 30.
    Espaillat A, Pérez O, Potvin R (2016) Clinical outcomes using standard phacoemulsification and femtosecond laser-assisted surgery with toric intraocular lenses. Clin Ophthalmol 10:555–563PubMedPubMedCentralGoogle Scholar
  31. 31.
    Elgohary MA, Beckingsale AB (2008) Effect of posterior capsular opacification on visual function in patients with monofocal and multifocal intraocular lenses. Eye (London) 22:613–619CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Peter Žiak
    • 1
    • 2
    Email author
  • Juraj Halička
    • 1
    • 2
  • Peter Mojžiš
    • 3
  • Karolína Kapitánová
    • 2
  • Javorka Michal
    • 4
  • David P. Piñero
    • 5
    Email author
  1. 1.Eye Clinic, Jessenius Faculty of MedicineComenius University in BratislavaMartinSlovakia
  2. 2.UVEA MEDIKLINIK, s.r.oMartinSlovakia
  3. 3.Premium ClinicTepliceCzech Republic
  4. 4.Department of Physiology, Jessenius Faculty of MedicineComenius UniversityMartinSlovakia
  5. 5.Department of Optics, Pharmacology and AnatomyUniversity of AlicanteSan Vicente del Raspeig, AlicanteSpain

Personalised recommendations