Combined Cataract and Refractive Corneal Inlay Implantation Surgery: Comparison of Three Techniques

Purpose: To compare clinical outcomes of three different techniques of combined cataract and Presbia Flexivue Microlens refractive corneal inlay (Presbia Coöperatief U.A., Amsterdam, Netherlands) implantation surgery for presbyopia compensation over a 12-month follow-up.

Methods: In this comparative pilot study, 15 patients with bilateral cataract were allocated to one of three groups with a different combination of surgical steps (cataract surgery, intrastromal pocket creation, and inlay implantation). In the three-step group, the intracorneal pocket was created in the non-dominant eye, bilateral cataract surgery was performed 3 months later, and the intracorneal inlay was inserted 3 months after that. In the two-step at 3 days group, bilateral cataract surgery was performed 3 days after pocket creation and inlay implantation in the non-dominant eye. In the two-step at 3 months group, the pocket creation and the inlay implantation were performed in the non-dominant eye 3 months after bilateral cataract surgery. Visual, refractive, and contrast sensitivity outcomes were evaluated and compared between the three groups.

Results: Twelve months after the inlay implantation, mean monocular uncorrected distance visual acuity was 20/32 in the three-step group, 20/32 in the two-step at 3 days group, and 20/25 in the two-step at 3 months group. Achieved mean monocular uncorrected near visual acuity was similar in the three groups (20/25). The visual and refractive outcomes did not show significant differences between groups. Contrast sensitivity was similar between groups under mesopic and photopic conditions. No intraoperative or postoperative complications were observed.

Conclusions: Clinical outcomes of three different techniques of combined cataract surgery and refractive corneal inlay implantation had no apparent differences between them. The corneal inlay provided excellent near vision acuity, with high patient satisfaction and a high spectacle independence rate after cataract surgery. [J Refract Surg. 2016;32(5):318-325.].