Enhancement-procedure outcomes in patients implanted with the Precisight multicomponent intraocular lens

Purpose: Eyes that have undergone phacoemulsification with implantation of a multicomponent intraocular lens (MCIOL) may further undergo an enhancement procedure for correction of residual refractive errors. The enhancement procedure is accomplished by exchanging the front lens used in the primary surgery with another lens containing the correct dioptric power. We evaluated the efficacy and safety of enhancement procedures among eyes that received an MCIOL. Methods: A total of 25 eyes that had undergone phacoemulsification with implantation of an MCIOL were found to have a residual error of refraction (spherical equivalent ≥0.75 D) 3 months after primary cataract surgery, and underwent further enhancement surgery. The main study outcomes were uncorrected and corrected distance visual acuity, subjective refraction, anterior-chamber depth, pachymetry, and endothelial cell count. Results: There was a statistically significant improvement in uncorrected distance visual acuity of approximately two lines after enhancement surgery (0.20±0.20–0.02±0.08 logMAR, P <0.001) and a significant decrease in residual spherical equivalent from 1.3±1.1 D to 0±0.38 D ( P <0.001). There were no statistically significant changes in pre- and postenhancement corrected distance visual acuity, anterior-chamber depth, pachymetry, or keratometry. There was a statistically significant decrease (2.6%) in endothelial cell count ( P <0.01), which could have been endothelial equilibration from the primary procedure. All enhancement surgeries were uneventful, and no major complications were observed. Conclusion: The MCIOL-enhancement procedure demonstrates statistical and clinical improvement in uncorrected distance visual acuity and correction of postoperative refractive errors. The Precisight IOL may be a useful choice for patients with high risk of having significant residual refractive errors after primary cataract surgery. Keywords: residual refractive error, cataract, piggyback lens, multicomponent intraocular lens, intraocular lens exchange, pseudophakic emmetropia