Add-On Sulcus-Based Versus Primary In-the-Bag Multifocal Intraocular Lens: Intraindividual Study

PURPOSE: To compare the clinical outcomes of add-on sulcus-based multifocal and standard in-the-bag multifocal intraocular lens (IOL) implantation. METHODS: Twenty-one patients with unilateral monofocal pseudophakia underwent add-on sulcus-based Acri. LISA 536D multifocal IOL (Carl Zeiss Meditec, Jena, Germany) implantation (add-on multifocal IOL group) and contralateral phacoemulsification with in-the-bag Acri. LISA 376D multifocal IOL (Carl Zeiss Meditec) implantation (primary multifocal IOL group). Uncorrected distance visual acuity, uncorrected near visual acuity, corrected distance visual acuity, distance-corrected near visual acuity, photopic (90 cd/m(2)) distance, near contrast sensitivity, mesopic (5 cd/m(2)) distance contrast sensitivity with and without glare, wavefront aberrations, and complications were measured 6 months postoperatively. RESULTS: Primary in-the-bag multifocal IOLs provided slightly but significantly better uncorrected distance visual acuity (0.08 +/- 0.10 vs 0.17 +/- 0.15 logMAR, P = .028), uncorrected near visual acuity (0.09 +/- 0.17 vs 0.18 +/- 0.11 logMAR, P = .005), and corrected distance visual acuity (0.01 +/- 0.04 vs 0.04 +/- 0.05 logMAR, P = .038). There were no significant differences in distance-corrected near visual acuity, photopic or mesopic contrast sensitivity under different conditions, and wavefront aberrations. Complications included pigment dispersion in one eye (4.8%) and pupillary capture in 2 eyes (9.5%) of the add-on multifocal IOL group. CONCLUSIONS: The secondary add-on sulcus-based multifocal IOL provided useful pseudoaccommodation with vision quality similar to the primary in-the-bag multifocal IOL. The technique should be considered in patients diagnosed as having unilateral or bilateral monofocal pseudophakia seeking near spectacle independence.