Clinical Outcomes of Trifocal Intraocular Lens with Glistening-Free Hydrophobic Acrylic: A One-Year Follow-Up Study

Clinical Outcomes of Trifocal Intraocular Lens with Glistening-Free Hydrophobic Acrylic: A One-Year Follow-Up Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Outcomes of Trifocal Intraocular Lens with Glistening-Free Hydrophobic Acrylic: A One-Year Follow-Up Study Sungho Choi, Yoon Seong Choi, Deok Jo Nam, Sungjin Na This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6088723/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Jul, 2025 Read the published version in BMC Ophthalmology → Version 1 posted 8 You are reading this latest preprint version Abstract PURPOSE The Clareon PanOptix (CNWT) IOL is a newer trifocal IOL made from a glistening-free hydrophobic acrylic material incorporating hydroxyethyl methacrylate (HEMA). While its predecessor (TFNT) has established clinical outcomes, long-term data. This study aimed to evaluate the refractive and visual outcomes during a 1-year follow-up after CNWT implantation in one eye, with a different type of refractive multifocal or extended depth of focus IOL in the contralateral eye (mix- and match setting). METHOD This was a retrospective, single-arm case series conducted at the single eye clinic, Seoul, Republic of Korea. The study included patients who underwent cataract surgery with mix-and-match IOL implantations, receiving a CNWT in one eye. Data were collected from the eyes with a CNWT. Monocular uncorrected distance visual acuity (UCDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UCNVA), and manifest refraction were analyzed from measurements taken at 1, 3, 6, and 12 months postoperatively. Rates and causes of secondary surgical intervention, such as IOL exchange and toric IOL axis readjustment, were also investigated. Statistical analysis involved Kolmogorov-Smirnov tests for normality and t-tests for comparisons, with p < 0.05 considered significant. RESULTS Data from 897 eyes (out of 1282 initially screened) with continuous measurements and no secondary interventional surgeries were included in the primary monocular visual acuity and refractive analysis. UCDVA of LogMAR 0.0 or better increased from 50.91% at 1 month to 85.95% at 12 months. CDVA of LogMAR 0.0 or better improved from 89.52% at 1 month to 98.1% at 12 months. At 12 months, 94.09% of eyes achieved UCNVA of LogMAR 0.1 or better. A slight mean hyperopic shift (+ 0.07D) was observed up to 12 months. Toric CNWT IOLs were used in 71.0% of these eyes, with 88.07% achieving manifest refractive astigmatism of ≤ -0.75D at 12 months. Overall, 85 out of 1282 eyes (6.63%) underwent secondary surgery: 4.45% for IOL exchange and 2.18% for toric IOL axis readjustment. Post-reoperation, UCDVA and UCNVA significantly improved. CONCLUSIONS The new hydrophobic acrylic trifocal IOL (CNWT) with HEMA demonstrated significant improvements in visual acuity and stable refractive outcomes over one year in a mix-and-match setting. The use of toric CNWT IOLs effectively reduced astigmatism. These findings suggest that this IOL is a reliable option for enhancing visual quality and reducing spectacle dependency in this specific implantation context. Despite the low rate of reoperations, the results underscore the ongoing need for advancements in biometric measurements and IOL power calculation formulas to further minimize such interventions. Trial registration Retrospectively registered. This study was approved by the Institutional Review Board of First Samsung Eye Clinic (No. FSEC202311HR00901, approved November 2023). glistening free trifocal IOL Figures Figure 1 Figure 2 Introduction Diffractive intraocular lenses (IOLs) initially provided bifocal functionality, but recently, trifocal IOLs that ensure functional intermediate vision have become widely used. As IOL capabilities have evolved, patient satisfaction has increased due to spectacle independence and improved visual quality. AcrySof PanOptix (TFNT, Alcon, Fort Worth, Texas, USA) is the first trifocal IOL with quadrifocal diffractive design. Through design modifications, it functions as a trifocal IOL. Clareon Panoptix (CNWT (Alcon, Fort Worth, Texas, USA)) retains the optical design of the original TFNT IOL. Panoptix design offers low pupillary dependence, ensuring similar visual performance across various lighting conditions. Additionally, it has a low frequency of glare and halos, making it a favorable option for patients seeking a good range of vision and a spectacle-free life. 1 However, the biggest difference is that Clareon is a hydrophobic acrylic IOL incorporated hydroxyethyl methacrylate (HEMA), which offers improved clarity compared to phenylethyl methacrylate (PEMA) material of TFNT. 2–4 The favorable clinical outcomes of TFNT have already been reported. However, to our knowledge, long-term follow-up results for CNWT have not yet been reported. Therefore, this study aimed to evaluate the outcomes during a 1-year follow-up after CNWT implantation. 5 Materials and methods Study design This retrospective study was performed by chart review of eyes that underwent conventional phacoemulsification and CNWT implantation from February 2022 to May 2023 at the First Samsung Eye Clinic, Seoul, Republic of Korea. All patients underwent mix-and-match IOL implantations with a CNWT in one eye and a refractive multifocal IOL or extended depth of focus IOL in the other. Data were collected from the eyes with a CNWT. This study was approved by the Institutional Review Board of First Samsung Eye Clinic (No. FSEC-202311-HR-009-01), and informed consent for the research was waived because of the retrospective nature of the study. We complied with the tenets of the Declaration of Helsinki. Patients This study included patients who underwent cataract surgery. The exclusion criteria were a history of corneal refractive surgery, trauma affecting vision, amblyopia, optic nerve diseases, glaucoma involving central visual fields, severe dry eye affecting examination, and corneal or retinal conditions affecting postoperative vision, such as corneal dystrophy, corneal opacity, active inflammation, and AMD. All patients underwent comprehensive preoperative examinations, including slit-lamp microscopy, specular microscopy (CEM-530, NIDEK CO, LDT, Japan), corneal tomography (Pentacam HR, Oculus, Germany), biometric measurements with IOLmaster 700 (Carl Zeiss Meditec Inc., Jena, Germany) and Argos (Alcon, Fort Worth, Texas, USA), fundus examination with ultra-widefield fundus photo (Daytona, Optos plc, Dunfermline, Scotland), and macular examination with a Cirrus OCT 5000 (Carl Zeiss Meditec Inc., Jena, Germany). Monocular visual acuity measured at 1, 3, 6 and 12 months postoperatively was analyzed. Data were used only from patients who underwent consecutive examinations during this period to confirm the trend in refraction and visual acuity changes over time. For refraction and distance and near vision, sufficient data were obtained from patients who were continuously measured during the examination period without any missing data. However, intermediate vision was not routinely evaluated for all patients. During the follow-up period, no patients had their intermediate vision measured consecutively. Therefore, it was difficult to identify trends over time, so each examination period was analyzed separately. These assessments include uncorrected and corrected distance visual acuity (UCDVA and CDVA), uncorrected near visual acuity (UCNVA), uncorrected intermediate visual acuity (UCIVA), and measurement of refractive error. Subjective refractions were performed by two experienced optometrists via retinoscopy and trial lenses. For distance visual acuity, decimal vision at 4 m was measured and converted to LogMAR. Near and intermediate visions were measured with the Lea-numbers® under photopic conditions (85 cd/m 2 ) at 40 cm and 60 cm. IOL power was calculated using Argos and IOLMaster700. The Barrett universal II and Holladay 2 formulae were employed, with Barrett II being the preferred choice in most cases. In instances where the results of the same formula from the two devices differed, one surgeon (SJ Na) followed the IOLMaster700 results, whereas the other surgeon (SH Choi) chose those from the Argos system. This trend was entirely dependent on individual preferences. Argos utilized distinct refractive indices for the anterior chamber depth, lens thickness, and vitreous cavity, whereas IOLmaster700 utilized a single index to reflect measurement values, resulting in occasional discrepancies between the two outcomes. Therefore, IOL constant was optimized with the initial 50 cases for Argos, and the optimized constant for the IOLmaster 700 was obtained from the User Group for Laser Interference Biometry (ULIB) website. A toric IOL was implanted in eyes with corneal astigmatism greater than 0.50 D. To determine the cylinder power of a toric IOL, the total corneal refractive power within the 4 mm zone from tomography was employed. Surgically induced astigmatism values of 0.1 diopters (temporal incision) and 0.3 diopters (superior incision) were applied. 6 Surgical technique Cataract surgeries were performed by two surgeons using Phacoemulsifier (Legion®, Alcon Inc.) through a 2.5 mm clear corneal incision under topical anesthesia (Proparacaine HCL 0.5%, Alcaine 0.5%, Alcon Inc.). Corneal incision placement confirmation, continuous curvilinear capsulorhexis (CCC), and axis alignment of the toric IOL were aided by a digital marker system (Verion™ Image Guided System, Alcon Inc.). Secondary surgical intervention Among the 1,282 eyes, cases that underwent IOL exchange and toric IOL axis repositioning were excluded from the analysis of visual and refractive changes and were analyzed separately. Reoperations were mainly done for patients unhappy with their vision, especially if postoperative UCDVA was LogMAR 0.1 or worse and/or UCNVA was worse than J3 (LogMAR 0.2), but corrected visual acuity was better than these values. Some patients with good uncorrected vision but poor vision quality also had reoperations if examinations showed it would help. In toric IOL cases, if there was a misalignment of toric axis or IOL rotation in the capsule, repositioning was performed. For an eye with an IOL of inappropriate power, IOL exchange was performed for an eye with an intact capsule. The spherical power of the new IOL was selected using the spherical equivalent (SE) to achieve emmetropia. If the toric power was not accurate, the new toric power was determined using the Astigmatismfix ( https://ascrs.org/tools/toric-results-analyzer ). While laser refractive surgery was considered for patients with posterior capsulotomy, but there were no cases. Statistical analysis Data were analyzed using SPSS (version 28.0; SPSS, Inc., Chicago, CA, USA). The normality of the data was tested via the Kolmogorov–Smirnov test. As the data were normally distributed, t tests were used to compare pre- and postoperative values, and a p value of 0.05 or less was considered statistically significant. Results Among the 1,282 eyes, 85 (6.63%) underwent IOL exchange or axis repositioning of the toric IOL. Excluding these, there were 897 eyes (69.97%) with continuous measurements of near and distance visual acuity and refractive results during examination period (Table 1 ). Table 1 Demographic data. Characteristics All eyes (N = 1282 eyes) Eyes with continuous measurements (N = 897 eyes) Reoperated eyes (N = 85 eyes) Age (years), n (%) < 65 1061 (82.76) 771 (85.95) 71 (83.53) ≥ 65 221 (17.23) 126 (14.05) 14 (16.47) Mean ± SD 57.99 ± 5.93 57.99 5.83 57.75 ± 5.57 Range (min, max) (36, 73) (36, 73) (48, 70) Sex, n (%) Female 871 (67.94) 624 (69.57) 61 (71.76) Male 411 (32.06) 273 (30.43) 24 (28.24) Visual acuity Monocular UCDVA and CDVA in eyes with a CNWT showed statistically significant differences in all periods except between the 3- and 6 months (paired t-test p = .087 and p = .662, respectively). The proportion of eyes with UCDVA of LogMAR 0.0 or better increased from 50.91% (457 eyes) at 1 month to 85.95% (771 eyes) at 12 months. CDVA improved from 89.52% (803 eyes) to 98.1% (880 eyes) in the same period. The percentage of eyes with UCDVA of worse than LogMAR 0.1 decreased from 8.81% (79 eyes) to 2.45% (22 eyes), and CDVA decreased from 1.45% (13 eyes) to 0.34% (3 eyes). UCNVA improved over time and showed statistically significant differences at all periods (paired t-test, p < .05) (Fig. 1 ). No continuous UCIVA testing was done during the follow-up. Results were collected at each examination period: 0.06 ± 0.11 (31 eyes) at 1 month, 0.04 ± 0.09 (35 eyes) at 3 months, 0.04 ± 0.13 (8 eyes) at 6 months, and 0.05 ± 0.09 (15 eyes) at 12 months postoperatively. Refractive outcomes Table 2 and Fig. 2 present the refractive outcomes of 897 eyes. A slight hyperopic shift (+ 0.07D) in postoperative SE was observed up to 12 months. The SE at 1 month postoperatively showed a statistically significant difference ( P < .05) compared to the remaining periods, but no statistical difference was observed after 3 months. Table 2 Postoperative spherical equivalent (897 eyes) and refractive cylinder (637 eyes with a toric IOL). Mean (± SD) range 1 m 3 m 6 m 12 m Spherical equivalent (D) -0.28 ± 0.44 -0.24 ± 0.41 -0.21 ± 0.43 -0.21 ± 0.43 -2.25 to 1.50 -1.375 to 1.00 -2.00 to 1.00 -1.38 to 2.25 Cylinder (D) -0.44 ± 0.39 -0.43 ± 0.41 -0.42 ± 0.38 -0.41 ± 0.38 -2.13 to 0.00 -2.35 to 0.00 -2.25 to 0.00 -2.25 to 0.00 Toric IOL outcomes Toric IOLs were implanted in 71.0% of the eyes (637 out of 897). The distribution of toric power of IOL was as follows: T2 39.1%, T3 19.0%, T4 8.0%, T6 3.1%; and T6 1.8%. At 12 months postoperatively, 88.07% (561 eyes) had a manifest refractive astigmatism of ≤ -0.75 D, whereas 3.92% (25 eyes) had residual astigmatism exceeding − 1.0 D (Table 2 ). There was no statistically significant difference in cylindrical error over the follow-up period. Secondary surgical intervention IOL exchanges were performed in 4.45% (57 out of 1,282 eyes), and axis readjustment of the toric IOLs was carried out in 2.18% (28 out of 1282 eyes) (Table 3 ). Table 3 Causes and frequency of secondary surgical intervention Eyes (%) of 1282 eyes IOL exchange 57 (4.45) Spherical power error 26 (2.03) Toric power error 9 (0.7) Sph + toric power error. 22 (1.72) Toric axis adjustment 28 (2.18) IOL rotation 8 (0.62) Inaccurate axis measurements or changes due to surgery 20 (1.56) In the case of IOL exchanges, the mean absolute SE was 1.01 ± 0.39 D (actual range: -1.5 to 1.12) before reoperation. Among them, 19 eyes (1.48%) had myopia or myopic astigmatism with a mean SE of -0.52 D (range: -0.01~ -1.0), and 38 eyes (2.96%) had hyperopia or hyperopic astigmatism with a mean SE of 0.53 D (range: 0.13~ -1.12). When the prediction error of the Barrett Universal II was checked, the likelihood of hyperopia was greater when the IOLMaster 700 was used (Table 4 ). Table 4 Prediction error of Barrett Universal II in eyes that underwent IOL exchange. Mean ± SD (Range) All eyes (N = 57 eyes) Hyperopia (N = 38 eyes) Myopia (N = 19 eyes) IOLmaster 700 -0.06 D ± 0.50 (-1.30 to 1.20) 0.47 D ± 0.33 (0.1 to 1.3) -0.36 ± 0.35 (-1.30 to -0.08) Argos 0.08 D ± 0.45 (-0.82 to 1.30) 0.39 D ± 0.34 (-0.14 to 1.20) -0.17 ± 0.33 (-0.82 to 0.40) P value .006 .002 .05 * For Argos, surgeon personalized lens constants were used. For IOLmaster 700, ULIB recommended lens constants were used. The mean pre-exchange UCDVA was LogMAR 0.13 (range: 0.00~ -0.40). Among the 57 eyes, 21 (36.84%) had a UCDVA of 0.1 or better. However, reoperation was performed likely due to hyperopia associated with UCNVA worse than LogMAR 0.2. Postoperatively, all eyes improved to a UCDVA of at least 0.04 and a UCNVA of at least 0.1. The average interval between the first surgery and reoperation was 66 days (range: 1 ~ 202 days), and in all patients, the new IOL was placed within the capsular bag. In 8 cases (0.62%) of IOL rotation. the toric axis was readjusted without exchanging the IOL. A mean rotation angle was 27° (range: 19° to 42°). This rotation occurred in IOLs with a mean power of 17.25 D, which was lower than the overall average of 19.86 D for all toric IOL cases, and in the eyes with a mean axial length of 24.67mm, longer than the overall average of 23.89 mm. In the remaining 20 eyes without IOL rotation (1.56%), the IOLs were within ± 5 degrees of the intended axis. However, these cases had significant astigmatism likely due to inaccurate preoperative corneal astigmatism measurements or significant surgically induced astigmatism. The eyes that underwent IOL axis repositioning recovered to a visual acuity of LogMAR 0.09 and J2 (LogMAR 0.1) or better for distance and near vision, respectively. There were no cases that were corrected with corneal ablation. Adverse events Posterior capsulotomy was performed in 76 eyes (5.93%), and epiretinal membrane was developed postoperatively in 8 eyes, 3 of which underwent retinal surgery. Discussion The analysis of the clinical data over one year revealed excellent refractive outcomes and visual acuity from distance to near after the implantation of the CNWT via the glistening-free acryl. Additionally, there was an improvement in visual acuity over time, which is consistent with previous studies on TFNT. 7 , 8 Since corrected visual acuity improved, neuroadaptation is considered the main factor for the enhancement of vision. 9 UCIVA was measured intermittently during the observation period, which is a limitation of this retrospective study; however, on the basis of our experience with TFNT, patients who were satisfied with UCDVA and UCNVA also had satisfactory intermediate visual acuity. 7 , 10 , 11 Since CNWT shares the optical characteristics of TFNT, intermediate visual acuity was not measured routinely. In practice, patients rarely reported discomfort with intermediate vision. The majority involved temporary blurring of monitor text, even though visual acuity was close to LogMAR 0.0. Over time, fewer patients experienced the discomfort, which is believed to be due to neural adaptation and improvement in corneal edema and postoperative dry eye syndrome. In a previous study, Jo et al. reported 95% complete spectacle independence after CNWT implantation. 12 In a meta-analysis using 13 studies of TFNT, approximately 91.6% of the patients achieved complete spectacle independence. 13 However, spectacle independence was not investigated in this study because all patients underwent mix and match. Gunenc and Celik speculated that using a single type of multifocal IOL might not provide the full range of vision and therefore proposed implanting two different types of multifocal IOLs—refractive and diffractive—contralaterally along with cataract surgery. 14 CNWT provides an almost full range of vision, as it achieves an average visual acuity of better than LogMAR 0.1 within the defocus curve range of + 0.5D to -3.0D. 15 Despite advancements in biometric measurements and IOL formulas, postoperative refractive surprises can still occur. Therefore, we prefer the mix and match approach, targeting minimal myopia for CNWT due to its strengths in intermediate and near vision, and minimal hyperopia for the other eye with a refractive type or extended depth of focus IOL, owing to its relatively better contrast sensitivity function for distance vision, to minimize the need for glasses. 16 , 17 However, high satisfaction rates have also been reported in cases where TFNT was implanted in both eyes. 7 Refractive stability is a crucial factor in visual prognosis. Observations over a year after Clareon monofocal IOL implantation revealed an SE change of approximately 0.1D. Similarly, our results obtained via CNWT on the same platform revealed a + 0.07D shift, demonstrating very stable refractive power. 18 , 19 In the toric IOL patients, the change in the refractive cylinder did not significantly differ during the examination period, and 88.02% of the patients were within − 0.75 D after one year, indicating very high refractive predictability and stability. Schartmüller et al. reported high rotational stability, observing an average rotation of 1.4° for six months after the implantation of toric Clareon monofocal IOLs. 20 Walters et al. reported an average rotation of 2.27° and an average change of less than 1° between one month and six months postoperatively. 21 In this study, IOL rotation was not directly confirmed in all eyes; instead, eyes with visual acuity less than 0.8 or symptoms of blurry vision were investigated. A total of 0.62% of the eyes had an average IOL rotation of 27°, which required axis repositioning. Long axial length, C-loop design, and large dimensions of the capsular bag are known risk factors for rotation. 22 In this study, rotation also associated with similar conditions. Although IOL rotation did not occur, axis repositioning was performed in 1.56% of cases because of residual astigmatism. In most cases, the corneal cylinder axis changed between the preoperative and postoperative examinations. These variations are often observed in eyes with dry eye symptoms and an irregular corneal surface on the topography map or when the axis of the corneal cylinder changes during surgery. Addressing dissatisfaction and reducing the rate of reoperation due to refractive surprises is crucial in IOL implantation. In this study, patients with unsatisfactory visual acuity were restored to normal by adjusting the IOL power, highlighting the necessity of improved biometric measurements, lens constant optimization and IOL formulas for the success of multifocal IOL implantation. Both Argos and IOLmaster700, which use swept-source OCT, exhibit high success rates in measuring axial length. Although several studies have shown differences in biometric values between the two devices, they are known to have a high correlation. 23 – 27 The IOLmaster700 measures axial length in the conventional way via a single equivalent refractive index, which results in an increased error as the axial length deviates from the average. 28 In contrast, the K value is obtained by measuring the posterior cornea with swept-source OCT, providing a total K. Argos is more accurate in cases of long or short axial lengths because of its use of segmented axial length measurements. 29 On the other hand, the K value uses the conventional method of the anterior corneal radius, which may result in lower accuracy than the IOLmaster700. Therefore, applying the same IOL constant to a different biometer may be associated with refractive surprise, making constant optimization essential. Additionally, since existing IOL formulas are based on data measured with a single equivalent refractive index, it seems necessary to develop a formula for the devices using segmented refractive index. However, the errors were discovered in unexpected areas. In 15 eyes where the IOL was exchanged due to hyperopia, the prediction error of the IOLmaster 700 was greater than that of the Argos. These cases were developed by the surgeon who preferred the IOLmaster700. The device yielded warning signs for LT values, but the Barrett universal II formula was used regardless. Upon review, it was found that lens thickness was underestimated in all these cases. As a result, the effective lens position was predicted to be closer to the cornea, likely leading to a lower required IOL power. Since there is no function to correct this in the IOLmaster 700, third-generation IOL formulas that do not utilize LT are safer. Conversely, Argos had no issues with LT measurement and allows for manual adjustments if needed. 30 , 31 Leveraging insights from our clinical experience with TFNT and CNWT implantation, we observed that discomfort increased when the UCDVA was below LogMAR 0.1 or when the UCNVA was below LogMAR 0.2. Proactive IOL exchanges with patient consent led to improved vision. These findings highlight the importance of further advancements in biometric measurements and IOL formulas. In particular, 66.67% of IOL exchanges were due to hyperopia, with the results of the IOLmaster 700 contributing significantly, highlighting the importance of selecting the right biometer. Conversely, reoperation due to myopia was not significantly different between the IOLmaster 700 and Argos groups. Previous studies comparing the two biometers have reported their outcomes using relatively small sample sizes and comparing means and standard deviations. 29 , 32 – 34 While this statistical approach is suitable for explaining average cases, it has limitations in explaining extreme cases. Our results, which were based on a larger sample size, showed partial differences compared with those of previous studies. However, detailed analysis results will be presented in a separate paper, as they fall beyond the scope of this study. The frequency of PCO did not differ between monofocal IOLs made of Clareon and Acrysoft materials, and the square design of both IOLs slows the occurrence of PCO. 35 , 36 However, Shah et al. reported that the frequency of posterior capsulotomy was greater for Acrysoft multifocal lenses than for monofocal lenses on the same platform. They noted that capsulotomy was performed to treat decreased vision after an average of 8.8 months in the multifocal lens group and 10.4 months in the monofocal lens group. 37 Lee et al. reported that performing capsulotomy within a year after the implantation of a single-piece foldable hydrophobic acrylic IOL (SN60AT, Alcon, Fort Worth, TX, USA) tends to be associated with a hyperopic shift. 38 However, our study did not reveal a significant difference in refractive power before and after Nd:YAG laser treatment. Factors such as the size of the capsulotomy, the size of the CCC, and the capsular polishing technique might have influenced this outcome, although additional research is needed to confirm this. The glistening of the TFNT does not affect Snellen visual acuity and the defocus curve but is known to reduce contrast sensitivity and increase subjective photic phenomena. 39 , 40 Oshika et al. and Hugo et al. reported that in their respective follow-up studies at one year (384 eyes) and three years (191 eyes) after the implantation of monofocal IOLs made of the same material as CNWT, no glistening was observed. 18 , 41 In our study, there were no cases of glistening. Considering the characteristics of multifocal IOLs, which divide light, resolving the glistening issue is naturally very beneficial for maintaining visual function. A limitation of this study is that it is a single-center, single-arm study, which means that there was no control group for evaluating the superiority of IOL functions. Additionally, being a retrospective study, it can identify statistically significant correlations but cannot explain causal relationships. The outcomes for the CNWT reflect unilateral implantation in a mix-and-match context, not bilateral use. Furthermore, surgeon-specific device use for IOL power calculation introduces variability not representative of a standardized protocol. UCIVA was measured intermittently during the observation period, which is another limitation. However, the surgeries were performed by two physicians in similar environments, with more than 1,200 cases being consecutively enrolled and examined. Two experienced optometrists conducted the examinations to ensure the accuracy of the results. Moreover, only the results of visual acuity and refraction that were continuously measured during the observation period were analyzed. Therefore, this study is believed to serve as an appropriate guide for clinicians intending to understand the clinical outcomes of using the CNWT in a mix-and-match setting. Conclusion The new hydrophobic acrylic trifocal IOL (CNWT) with HEMA demonstrated significant improvements in visual acuity and refractive outcomes within one year in a mix-and-match setting, with minimal reoperations needed. The use of toric IOLs effectively reduced astigmatism. These findings highlight this IOL as a reliable option for enhancing visual quality and reducing dependency on spectacles in this specific context. However, despite the low rate of reoperations, further advancements in biometry and IOL formulas are necessary to reduce them even further. The intermittent measurement of UCIVA is a limitation of this study. Abbreviations and Acronyms UCDVA uncorrected distance visual acuity CDVA corrected distance visual acuity UCNVA uncorrected near visual acuity UCIVA uncorrected intermediate visual acuity HOA high-order aberrations IOL intraocular lens HEMA hydroxyethyl methacrylate PEMA phenylethyl methacrylate SD standard deviation SE spherical equivalent Sph Spherical Declarations Ethics declarations Ethics approval and consent to participate: This study was approved by Ethics Committee (FSEC-20211-HR-009-01) of the First Samsung Eye Clinic, and it conformed to the tenets of the Declaration of Helsinki. Before surgery, written informed consent was obtained from all subjects. Consent for publication: Not applicable. Competing interest: The authors declare no competing interests. Data availability The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request Funding This study was funded by Alcon Research LLC, Fort Worth, TX, USA, and Alcon Korea Ltd., Seoul, South Korea (Grand ID 89017199). The funding organization had no role in the design or conduct of this research. Author information S Choi and Y Choi contributed equally to this work. Authors' contributions: S Choi and Y Choi participated in the study design, data analysis and interpretation, and manuscript writing. D Nam and S Na were involved in data collection. All authors reviewed this manuscript. Acknowledgements Not applicable References García-Pérez JL, Gros-Otero J, Sánchez-Ramos C, Blázquez V, Contreras I. Short term visual outcomes of a new trifocal intraocular lens. BMC Ophthalmol. 2017;17(1):72. 10.1186/s12886-017-0462-y . Oshika T, Fujita Y, Inamura M, Miyata K. Mid-term and long-term clinical assessments of a new 1-piece hydrophobic acrylic IOL with hydroxyethyl methacrylate. J Cataract Refract Surg. 2020;46(5):682–7. 10.1097/j.jcrs.0000000000000142 . Kinoshita K, Miyata K, Nejima R, Honbo M, Mori Y, Minami K. Surface light scattering from 1-piece hydrophobic acrylic intraocular lenses with hydroxyethyl methacrylate: contralateral observation for 7 years. J Cataract Refract Surg. 2021;47(6):702–5. 10.1097/j.jcrs.0000000000000621 . Werner L, Thatthamla I, Ong M, et al. Evaluation of clarity characteristics in a new hydrophobic acrylic IOL in comparison to commercially available IOLs. J Cataract Refract Surg. 2019;45(10):1490–7. 10.1016/j.jcrs.2019.05.017 . Yamashita K, Hayashi K, Hata S. Clinical performance and shape analysis of trifocal intraocular lenses via scanning electron microscopy. BMC Ophthalmol. 2024;24(1). 10.1186/s12886-024-03355-3 . Alpins NA. A new method of analyzing vectors for changes in astigmatism. 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Sahin V, Unal M, Ayaz Y. Outcomes after bilateral implantation of AcrySof IQ PanOptix trifocal intraocular lens: a prospective interventional study. Med Hypothesis Discovery Innov Ophthalmol. 2023;12(1):36–45. 10.51329/mehdiophthal1468 . Jo E, Kim B, Kim TI, Kim MK, Choi CY. Clinical Outcomes of a New Hydrophobic Trifocal Intraocular Lens with Hydroxyethyl Methacrylate in Cataract Surgery: A Prospective Multicenter Study. Korean J Ophthalmol. 2024;38(3):212–20. 10.3341/kjo.2023.0140 . Zhu D, Ren S, Mills K, Hull J, Dhariwal M. Rate of Complete Spectacle Independence with a Trifocal Intraocular Lens: A Systematic Literature Review and Meta-Analysis. Ophthalmol Ther. 2023;12(2):1157–71. 10.1007/s40123-023-00657-5 . Gunenc U, Celik L. Long-term experience with mixing and matching refractive array and diffractive CeeOn multifocal intraocular lenses. J Refract Surg. 2008;24(3):233–42. 10.3928/1081597X-20080301-04 . de Medeiros AL, de Araujo Rolim AG, Motta AFP, et al. Comparison of visual outcomes after bilateral implantation of a diffractive trifocal intraocular lens and blended implantation of an extended depth of focus intraocular lens with a diffractive bifocal intraocular lens. Clin Ophthalmol. 2017;11:1911–6. 10.2147/OPTH.S145945 . Hayashi K, Sato T, Igarashi C, Yoshida M. Effect of Spherical Equivalent Error on Visual Acuity at Various Distances in Eyes With a Trifocal Intraocular Lens. J Refract Surg. 2019;35(5):274–9. 10.3928/1081597X-20190404-01 . Won YK, Choi SH, Chung TY, Lim DH. Clinical Outcomes after Bilateral Implantation of a Wavefront-Shaping Extended Depth of Focus (EDOF) IOL with Mini-Monovision. J Clin Med. 2024;13(11). 10.3390/jcm13113225 . Oshika T, Sasaki N. One-year multicenter evaluation of a new hydrophobic acrylic intraocular lens with hydroxyethyl methacrylate in an automated preloaded delivery system. J Cataract Refract Surg. 2022;48(3):275–9. 10.1097/j.jcrs.0000000000000746 . Nuijts RMMA, Bhatt U, Nanavaty MA, Roberts TV, Peterson R, Teus MA. Three-year multinational clinical study on an aspheric hydrophobic acrylic intraocular lens. In: Journal of Cataract and Refractive Surgery . Vol 49. Lippincott Williams and Wilkins; 2023:672–678. 10.1097/j.jcrs.0000000000001173 Schartmüller D, Lisy M, Mahnert N, et al. Rotational stability and refractive outcomes of a new hydrophobic acrylic toric intraocular lens. Eye Vis. 2024;11(1). 10.1186/s40662-024-00393-2 . Walters TR, Lehmann R, Moyes A, French JW, Sreenivasan V, Modi SS. Rotational Stability of the Clareon Monofocal Aspheric Hydrophobic Acrylic Intraocular Lens 6 Months After Implantation. Clin Ophthalmol. 2022;16:401–9. 10.2147/OPTH.S348551 . Lin X, Ma D, Yang J. Insights into the rotational stability of toric intraocular lens implantation: diagnostic approaches, influencing factors and intervention strategies. Front Med (Lausanne). 2024;11:1349496. 10.3389/fmed.2024.1349496 . Huang J, Chen H, Li Y, et al. Comprehensive Comparison of Axial Length Measurement With Three Swept-Source OCT-Based Biometers and Partial Coherence Interferometry. J Refract Surg. 2019;35(2):115–20. 10.3928/1081597X-20190109-01 . Sabatino F, Matarazzo F, Findl O, Maurino V. Comparative analysis of 2 swept-source optical coherence tomography biometers. J Cataract Refract Surg. 2019;45(8):1124–9. 10.1016/j.jcrs.2019.03.020 . Tamaoki A, Kojima T, Hasegawa A, et al. Clinical Evaluation of a New Swept-Source Optical Coherence Biometer That Uses Individual Refractive Indices to Measure Axial Length in Cataract Patients. Ophthalmic Res. 2019;62(1):11–23. 10.1159/000496690 . Omoto MK, Torii H, Masui S, Ayaki M, Tsubota K, Negishi K. Ocular biometry and refractive outcomes using two swept-source optical coherence tomography-based biometers with segmental or equivalent refractive indices. Sci Rep. 2019;9(1):6557. 10.1038/s41598-019-42968-3 . Yang CM, Lim DH, Kim HJ, Chung TY. Comparison of two swept-source optical coherence tomography biometers and a partial coherence interferometer. PLoS ONE. 2019;14(10):e0223114. 10.1371/journal.pone.0223114 . Kenny PI, Kozhaya K, Truong P, et al. Efficacy of segmented axial length and artificial intelligence approaches to intraocular lens power calculation in short eyes. J Cataract Refract Surg. 2023;49(7):697–703. 10.1097/j.jcrs.0000000000001185 . Montés-Micó R, Pastor-Pascual F, Ruiz-Mesa R, Tañá-Rivero P. Ocular biometry with swept-source optical coherence tomography. J Cataract Refract Surg. 2021;47(6):802–14. 10.1097/j.jcrs.0000000000000551 . Wang L, Koch DD. Modified axial length adjustment formulas in long eyes. J Cataract Refract Surg. 2018;44(11):1396–7. 10.1016/j.jcrs.2018.07.049 . Wang L, Holladay JT, Koch DD. Wang-Koch axial length adjustment for the Holladay 2 formula in long eyes. J Cataract Refract Surg. 2018;44(10):1291–2. 10.1016/j.jcrs.2018.06.057 . Tañá-Rivero P, Aguilar-Córcoles S, Tañá-Sanz P, Tañá-Sanz S, Montés-Micó R. Axial length acquisition success rates and agreement of four optical biometers and one ultrasound biometer in eyes with dense cataracts. Eye Vis. 2023;10(1). 10.1186/s40662-023-00352-3 . Románek J, Sluková K. Comparison of Optical Biometers Argos and IOL MASTER 700. Czech Slovak Ophthalmol. 2021;77(6):296–300. 10.31348/2021/35 . Porwolik M, Porwolik A, Mrukwa-Kominek E. Evaluation of Selected Biometric Parameters in Cataract Patients-A Comparison between Argos® and IOLMaster 700®: Two Swept-Source Optical Coherence Tomography-Based Biometers. Med (Kaunas). 2024;60(7). 10.3390/medicina60071057 . Hillenmayer A, Wertheimer CM, Kassumeh S, et al. Evaluation of posterior capsule opacification of the Alcon Clareon IOL vs the Alcon Acrysof IOL using a human capsular bag model. BMC Ophthalmol. 2020;20(1). 10.1186/s12886-020-01349-5 . Nishi O, Nishi K, Sakanishi K. Inhibition of migrating lens epithelial cells at the capsular bend created by the rectangular optic edge of a posterior chamber intraocular lens. Ophthalmic Surg Lasers. 1998;29(7):587–94. Shah VC, Russo C, Cannon R, Davidson R, Taravella MJ. Incidence of Nd:YAG Capsulotomy After Implantation of AcrySof Multifocal and Monofocal Intraocular Lenses: A Case Controlled Study. J Refract Surg. 2010;26(8):565–8. 10.3928/1081597X-20100303-01 . Lee CY, Lu TT, Meir YJJ, et al. Refractive Changes Following Premature Posterior Capsulotomy Using Neodymium:Yttrium-Aluminum-Garnet Laser. J Pers Med. 2022;12(2). 10.3390/jpm12020272 . Yamashita K, Hayashi K, Hata S. Clinical performance and shape analysis of trifocal intraocular lenses via scanning electron microscopy. BMC Ophthalmol. 2024;24(1):86. 10.1186/s12886-024-03355-3 . Lee YW, Choi CY, Moon K, et al. Clinical outcomes of new multifocal intraocular lenses with hydroxyethyl methacrylate and comparative results of contrast sensitivity, objective scatter, and subjective photic phenomena. BMC Ophthalmol. 2022;22(1). 10.1186/s12886-022-02600-x . Hugo B, Emilie A, Jérémy B, et al. Long-term real-life outcomes of the Clareon® hydrophobic intraocular lens: the Clarte study in 191 eyes: 3-years real-life outcomes of the Clareon® intraocular lens. BMC Ophthalmol. 2024;24(1). 10.1186/s12886-024-03393-x . Additional Declarations Competing interest reported. This study was an investigator-initiated trial funded by Alcon Research LLC, Fort Worth, TX, USA, and Alcon Korea Ltd., Seoul, South Korea. The funding organization had no role in the design or conduct of this research. Cite Share Download PDF Status: Published Journal Publication published 01 Jul, 2025 Read the published version in BMC Ophthalmology → Version 1 posted Editorial decision: Revision requested 04 Jun, 2025 Reviews received at journal 02 Jun, 2025 Reviews received at journal 27 May, 2025 Reviewers agreed at journal 26 May, 2025 Reviewers agreed at journal 15 May, 2025 Reviewers invited by journal 13 May, 2025 Submission checks completed at journal 12 May, 2025 First submitted to journal 11 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6088723","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":455777146,"identity":"84b19480-35f0-44fb-9558-b59d0456e18d","order_by":0,"name":"Sungho Choi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYFACHgZmIJnAwMx8QIJYLYzNEC1sCVAtzMRqYeAxIE4Lv3Tv8ccFDHZ5/Ow8H2/8bNvGYM7efwCvFsk55xKbZzAkF0s282627G27zWDZcxi/LQY3cgybef8dSNxwmHebBC9Qi8GNZCK08DCAtPA8k/wL0nL/MfFa2KQhthDwvuScM4azeRiSE2c2sxlby5y7zWNwJtkArxZ+6R6DzzwMdon9/Icf3nxTdlvO4PjBB/itQY9xHvzKsWkZBaNgFIyCUYABAEaDQ/qAeqLkAAAAAElFTkSuQmCC","orcid":"","institution":"First Samsung Eye Clinic","correspondingAuthor":true,"prefix":"","firstName":"Sungho","middleName":"","lastName":"Choi","suffix":""},{"id":455777147,"identity":"92fae31a-8133-4fb8-833a-8b2108f74be0","order_by":1,"name":"Yoon Seong Choi","email":"","orcid":"","institution":"Stony Brook University","correspondingAuthor":false,"prefix":"","firstName":"Yoon","middleName":"Seong","lastName":"Choi","suffix":""},{"id":455777148,"identity":"46af16c9-7bf4-442a-a634-06f5d2ecc209","order_by":2,"name":"Deok Jo Nam","email":"","orcid":"","institution":"First Samsung Eye Clinic","correspondingAuthor":false,"prefix":"","firstName":"Deok","middleName":"Jo","lastName":"Nam","suffix":""},{"id":455777149,"identity":"0b2ac886-c6a9-4002-bcd5-5d389f095b32","order_by":3,"name":"Sungjin Na","email":"","orcid":"","institution":"First Samsung Eye Clinic","correspondingAuthor":false,"prefix":"","firstName":"Sungjin","middleName":"","lastName":"Na","suffix":""}],"badges":[],"createdAt":"2025-02-23 07:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6088723/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6088723/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12886-025-04198-2","type":"published","date":"2025-07-01T15:58:02+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82758455,"identity":"04a0f01d-54db-41f1-a099-726d84e5253a","added_by":"auto","created_at":"2025-05-15 02:22:38","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":180301,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in LogMAR visual acuity over time. This graph shows the changes and distributions of uncorrected distance visual acuity (UCDVA), best corrected distance visual acuity (BCDVA) and uncorrected near visual acuity (UCNVA) in eyes implanted with the CNWT over the 12-month follow-up period.\u003c/p\u003e","description":"","filename":"Figure1.TrendsinLogMARvisualacuityovertime..jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6088723/v1/5cf44010662c57dc6a9e3143.jpg"},{"id":82759844,"identity":"53dd9afa-e9bd-4ef7-982f-4c02430a00a6","added_by":"auto","created_at":"2025-05-15 02:38:38","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":67209,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of absolute spherical equivalent over time. This graph illustrates the changes in the mean absolute spherical equivalent refraction in 897 eyes implanted with the CNWT over the 12-month follow-up period.\u003c/p\u003e","description":"","filename":"Figure2.Distributionofabsolutesphericalequivalentovertime.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6088723/v1/804ed8dd5dead0a288c308d3.jpg"},{"id":86179117,"identity":"30368de9-4801-4a38-a678-bc0a0b478122","added_by":"auto","created_at":"2025-07-07 16:15:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":943302,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6088723/v1/4c572d5a-d726-429d-93f7-a86f0fc44ac3.pdf"}],"financialInterests":"Competing interest reported. This study was an investigator-initiated trial funded by Alcon Research LLC, Fort Worth, TX, USA, and Alcon Korea Ltd., Seoul, South Korea. The funding organization had no role in the design or conduct of this research.","formattedTitle":"Clinical Outcomes of Trifocal Intraocular Lens with Glistening-Free Hydrophobic Acrylic: A One-Year Follow-Up Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDiffractive intraocular lenses (IOLs) initially provided bifocal functionality, but recently, trifocal IOLs that ensure functional intermediate vision have become widely used. As IOL capabilities have evolved, patient satisfaction has increased due to spectacle independence and improved visual quality.\u003c/p\u003e\n\u003cp\u003eAcrySof PanOptix (TFNT, Alcon, Fort Worth, Texas, USA) is the first trifocal IOL with quadrifocal diffractive design. Through design modifications, it functions as a trifocal IOL. Clareon Panoptix (CNWT (Alcon, Fort Worth, Texas, USA)) retains the optical design of the original TFNT IOL. Panoptix design offers low pupillary dependence, ensuring similar visual performance across various lighting conditions. Additionally, it has a low frequency of glare and halos, making it a favorable option for patients seeking a good range of vision and a spectacle-free life.\u003csup\u003e1\u003c/sup\u003e However, the biggest difference is that Clareon is a hydrophobic acrylic IOL incorporated hydroxyethyl methacrylate (HEMA), which offers improved clarity compared to phenylethyl methacrylate (PEMA) material of TFNT.\u003csup\u003e2–4\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe favorable clinical outcomes of TFNT have already been reported. However, to our knowledge, long-term follow-up results for CNWT have not yet been reported. Therefore, this study aimed to evaluate the outcomes during a 1-year follow-up after CNWT implantation.\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eStudy design\u003c/p\u003e \u003cp\u003eThis retrospective study was performed by chart review of eyes that underwent conventional phacoemulsification and CNWT implantation from February 2022 to May 2023 at the First Samsung Eye Clinic, Seoul, Republic of Korea. All patients underwent mix-and-match IOL implantations with a CNWT in one eye and a refractive multifocal IOL or extended depth of focus IOL in the other. Data were collected from the eyes with a CNWT.\u003c/p\u003e \u003cp\u003eThis study was approved by the Institutional Review Board of First Samsung Eye Clinic (No. FSEC-202311-HR-009-01), and informed consent for the research was waived because of the retrospective nature of the study. We complied with the tenets of the Declaration of Helsinki.\u003c/p\u003e \u003cp\u003ePatients\u003c/p\u003e \u003cp\u003eThis study included patients who underwent cataract surgery. The exclusion criteria were a history of corneal refractive surgery, trauma affecting vision, amblyopia, optic nerve diseases, glaucoma involving central visual fields, severe dry eye affecting examination, and corneal or retinal conditions affecting postoperative vision, such as corneal dystrophy, corneal opacity, active inflammation, and AMD.\u003c/p\u003e \u003cp\u003eAll patients underwent comprehensive preoperative examinations, including slit-lamp microscopy, specular microscopy (CEM-530, NIDEK CO, LDT, Japan), corneal tomography (Pentacam HR, Oculus, Germany), biometric measurements with IOLmaster 700 (Carl Zeiss Meditec Inc., Jena, Germany) and Argos (Alcon, Fort Worth, Texas, USA), fundus examination with ultra-widefield fundus photo (Daytona, Optos plc, Dunfermline, Scotland), and macular examination with a Cirrus OCT 5000 (Carl Zeiss Meditec Inc., Jena, Germany).\u003c/p\u003e \u003cp\u003eMonocular visual acuity measured at 1, 3, 6 and 12 months postoperatively was analyzed. Data were used only from patients who underwent consecutive examinations during this period to confirm the trend in refraction and visual acuity changes over time. For refraction and distance and near vision, sufficient data were obtained from patients who were continuously measured during the examination period without any missing data. However, intermediate vision was not routinely evaluated for all patients. During the follow-up period, no patients had their intermediate vision measured consecutively. Therefore, it was difficult to identify trends over time, so each examination period was analyzed separately. These assessments include uncorrected and corrected distance visual acuity (UCDVA and CDVA), uncorrected near visual acuity (UCNVA), uncorrected intermediate visual acuity (UCIVA), and measurement of refractive error. Subjective refractions were performed by two experienced optometrists via retinoscopy and trial lenses. For distance visual acuity, decimal vision at 4 m was measured and converted to LogMAR. Near and intermediate visions were measured with the Lea-numbers\u0026reg; under photopic conditions (85 cd/m\u003csup\u003e2\u003c/sup\u003e) at 40 cm and 60 cm.\u003c/p\u003e \u003cp\u003eIOL power was calculated using Argos and IOLMaster700. The Barrett universal II and Holladay 2 formulae were employed, with Barrett II being the preferred choice in most cases. In instances where the results of the same formula from the two devices differed, one surgeon (SJ Na) followed the IOLMaster700 results, whereas the other surgeon (SH Choi) chose those from the Argos system. This trend was entirely dependent on individual preferences. Argos utilized distinct refractive indices for the anterior chamber depth, lens thickness, and vitreous cavity, whereas IOLmaster700 utilized a single index to reflect measurement values, resulting in occasional discrepancies between the two outcomes. Therefore, IOL constant was optimized with the initial 50 cases for Argos, and the optimized constant for the IOLmaster 700 was obtained from the User Group for Laser Interference Biometry (ULIB) website.\u003c/p\u003e \u003cp\u003eA toric IOL was implanted in eyes with corneal astigmatism greater than 0.50 D. To determine the cylinder power of a toric IOL, the total corneal refractive power within the 4 mm zone from tomography was employed. Surgically induced astigmatism values of 0.1 diopters (temporal incision) and 0.3 diopters (superior incision) were applied.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSurgical technique\u003c/p\u003e \u003cp\u003eCataract surgeries were performed by two surgeons using Phacoemulsifier (Legion\u0026reg;, Alcon Inc.) through a 2.5 mm clear corneal incision under topical anesthesia (Proparacaine HCL 0.5%, Alcaine 0.5%, Alcon Inc.). Corneal incision placement confirmation, continuous curvilinear capsulorhexis (CCC), and axis alignment of the toric IOL were aided by a digital marker system (Verion\u0026trade; Image Guided System, Alcon Inc.).\u003c/p\u003e \u003cp\u003eSecondary surgical intervention\u003c/p\u003e \u003cp\u003eAmong the 1,282 eyes, cases that underwent IOL exchange and toric IOL axis repositioning were excluded from the analysis of visual and refractive changes and were analyzed separately. Reoperations were mainly done for patients unhappy with their vision, especially if postoperative UCDVA was LogMAR 0.1 or worse and/or UCNVA was worse than J3 (LogMAR 0.2), but corrected visual acuity was better than these values. Some patients with good uncorrected vision but poor vision quality also had reoperations if examinations showed it would help. In toric IOL cases, if there was a misalignment of toric axis or IOL rotation in the capsule, repositioning was performed. For an eye with an IOL of inappropriate power, IOL exchange was performed for an eye with an intact capsule. The spherical power of the new IOL was selected using the spherical equivalent (SE) to achieve emmetropia. If the toric power was not accurate, the new toric power was determined using the Astigmatismfix (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ascrs.org/tools/toric-results-analyzer\u003c/span\u003e\u003cspan address=\"https://ascrs.org/tools/toric-results-analyzer\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). While laser refractive surgery was considered for patients with posterior capsulotomy, but there were no cases.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS (version 28.0; SPSS, Inc., Chicago, CA, USA). The normality of the data was tested via the Kolmogorov\u0026ndash;Smirnov test. As the data were normally distributed, t tests were used to compare pre- and postoperative values, and a \u003cem\u003ep\u003c/em\u003e value of 0.05 or less was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAmong the 1,282 eyes, 85 (6.63%) underwent IOL exchange or axis repositioning of the toric IOL. Excluding these, there were 897 eyes (69.97%) with continuous measurements of near and distance visual acuity and refractive results during examination period (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic data.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll eyes\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1282 eyes)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEyes with continuous\u003c/p\u003e \u003cp\u003emeasurements\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;897 eyes)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReoperated eyes\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;85 eyes)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years), n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1061 (82.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e771 (85.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71 (83.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e221 (17.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126 (14.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (16.47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.99\u0026thinsp;\u0026plusmn;\u0026thinsp;5.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.99 5.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.75\u0026thinsp;\u0026plusmn;\u0026thinsp;5.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange (min, max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(36, 73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(36, 73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(48, 70)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e871 (67.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e624 (69.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61 (71.76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e411 (32.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e273 (30.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (28.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eVisual acuity\u003c/h3\u003e\n\u003cp\u003eMonocular UCDVA and CDVA in eyes with a CNWT showed statistically significant differences in all periods except between the 3- and 6 months (paired t-test \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.087 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.662, respectively). The proportion of eyes with UCDVA of LogMAR 0.0 or better increased from 50.91% (457 eyes) at 1 month to 85.95% (771 eyes) at 12 months. CDVA improved from 89.52% (803 eyes) to 98.1% (880 eyes) in the same period. The percentage of eyes with UCDVA of worse than LogMAR 0.1 decreased from 8.81% (79 eyes) to 2.45% (22 eyes), and CDVA decreased from 1.45% (13 eyes) to 0.34% (3 eyes). UCNVA improved over time and showed statistically significant differences at all periods (paired t-test, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eNo continuous UCIVA testing was done during the follow-up. Results were collected at each examination period: 0.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11 (31 eyes) at 1 month, 0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09 (35 eyes) at 3 months, 0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13 (8 eyes) at 6 months, and 0.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09 (15 eyes) at 12 months postoperatively.\u003c/p\u003e\n\u003ch3\u003eRefractive outcomes\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e present the refractive outcomes of 897 eyes. A slight hyperopic shift (+\u0026thinsp;0.07D) in postoperative SE was observed up to 12 months. The SE at 1 month postoperatively showed a statistically significant difference (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05) compared to the remaining periods, but no statistical difference was observed after 3 months.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostoperative spherical equivalent (897 eyes) and refractive cylinder (637 eyes with a toric IOL).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (\u0026plusmn;\u0026thinsp;SD) range\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 m\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 m\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 m\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 m\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSpherical equivalent (D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.25 to 1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.375 to 1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.00 to 1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.38 to 2.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCylinder (D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.13 to 0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.35 to 0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.25 to 0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-2.25 to 0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eToric IOL outcomes\u003c/h3\u003e\n\u003cp\u003eToric IOLs were implanted in 71.0% of the eyes (637 out of 897). The distribution of toric power of IOL was as follows: T2 39.1%, T3 19.0%, T4 8.0%, T6 3.1%; and T6 1.8%.\u003c/p\u003e \u003cp\u003eAt 12 months postoperatively, 88.07% (561 eyes) had a manifest refractive astigmatism of \u0026le; -0.75 D, whereas 3.92% (25 eyes) had residual astigmatism exceeding \u0026minus;\u0026thinsp;1.0 D (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). There was no statistically significant difference in cylindrical error over the follow-up period.\u003c/p\u003e\n\u003ch3\u003eSecondary surgical intervention\u003c/h3\u003e\n\u003cp\u003eIOL exchanges were performed in 4.45% (57 out of 1,282 eyes), and axis readjustment of the toric IOLs was carried out in 2.18% (28 out of 1282 eyes) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCauses and frequency of secondary surgical intervention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEyes (%) of 1282 eyes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIOL exchange\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57 (4.45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpherical power error\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26 (2.03)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eToric power error\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (0.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSph\u0026thinsp;+\u0026thinsp;toric power error.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (1.72)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eToric axis adjustment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (2.18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIOL rotation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (0.62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInaccurate axis measurements or changes due to surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (1.56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the case of IOL exchanges, the mean absolute SE was 1.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39 D (actual range: -1.5 to 1.12) before reoperation. Among them, 19 eyes (1.48%) had myopia or myopic astigmatism with a mean SE of -0.52 D (range: -0.01~ -1.0), and 38 eyes (2.96%) had hyperopia or hyperopic astigmatism with a mean SE of 0.53 D (range: 0.13~ -1.12). When the prediction error of the Barrett Universal II was checked, the likelihood of hyperopia was greater when the IOLMaster 700 was used (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrediction error of Barrett Universal II in eyes that underwent IOL exchange.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (Range)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll eyes\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;57 eyes)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHyperopia\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;38 eyes)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMyopia\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;19 eyes)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIOLmaster 700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.06 D\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003cp\u003e(-1.30 to 1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.47 D\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e \u003cp\u003e(0.1 to 1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003cp\u003e(-1.30 to -0.08)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArgos\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.08 D\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003cp\u003e(-0.82 to 1.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.39 D\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003cp\u003e(-0.14 to 1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e \u003cp\u003e(-0.82 to 0.40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e* For Argos, surgeon personalized lens constants were used. For IOLmaster 700, ULIB recommended lens constants were used.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe mean pre-exchange UCDVA was LogMAR 0.13 (range: 0.00~ -0.40). Among the 57 eyes, 21 (36.84%) had a UCDVA of 0.1 or better. However, reoperation was performed likely due to hyperopia associated with UCNVA worse than LogMAR 0.2. Postoperatively, all eyes improved to a UCDVA of at least 0.04 and a UCNVA of at least 0.1. The average interval between the first surgery and reoperation was 66 days (range: 1\u0026thinsp;~\u0026thinsp;202 days), and in all patients, the new IOL was placed within the capsular bag.\u003c/p\u003e \u003cp\u003eIn 8 cases (0.62%) of IOL rotation. the toric axis was readjusted without exchanging the IOL. A mean rotation angle was 27\u0026deg; (range: 19\u0026deg; to 42\u0026deg;). This rotation occurred in IOLs with a mean power of 17.25 D, which was lower than the overall average of 19.86 D for all toric IOL cases, and in the eyes with a mean axial length of 24.67mm, longer than the overall average of 23.89 mm. In the remaining 20 eyes without IOL rotation (1.56%), the IOLs were within \u0026plusmn;\u0026thinsp;5 degrees of the intended axis. However, these cases had significant astigmatism likely due to inaccurate preoperative corneal astigmatism measurements or significant surgically induced astigmatism. The eyes that underwent IOL axis repositioning recovered to a visual acuity of LogMAR 0.09 and J2 (LogMAR 0.1) or better for distance and near vision, respectively.\u003c/p\u003e \u003cp\u003eThere were no cases that were corrected with corneal ablation.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAdverse events\u003c/h2\u003e \u003cp\u003ePosterior capsulotomy was performed in 76 eyes (5.93%), and epiretinal membrane was developed postoperatively in 8 eyes, 3 of which underwent retinal surgery.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe analysis of the clinical data over one year revealed excellent refractive outcomes and visual acuity from distance to near after the implantation of the CNWT via the glistening-free acryl. Additionally, there was an improvement in visual acuity over time, which is consistent with previous studies on TFNT.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Since corrected visual acuity improved, neuroadaptation is considered the main factor for the enhancement of vision.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eUCIVA was measured intermittently during the observation period, which is a limitation of this retrospective study; however, on the basis of our experience with TFNT, patients who were satisfied with UCDVA and UCNVA also had satisfactory intermediate visual acuity.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Since CNWT shares the optical characteristics of TFNT, intermediate visual acuity was not measured routinely. In practice, patients rarely reported discomfort with intermediate vision. The majority involved temporary blurring of monitor text, even though visual acuity was close to LogMAR 0.0. Over time, fewer patients experienced the discomfort, which is believed to be due to neural adaptation and improvement in corneal edema and postoperative dry eye syndrome.\u003c/p\u003e \u003cp\u003eIn a previous study, Jo et al. reported 95% complete spectacle independence after CNWT implantation.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e In a meta-analysis using 13 studies of TFNT, approximately 91.6% of the patients achieved complete spectacle independence. \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e However, spectacle independence was not investigated in this study because all patients underwent mix and match. Gunenc and Celik speculated that using a single type of multifocal IOL might not provide the full range of vision and therefore proposed implanting two different types of multifocal IOLs\u0026mdash;refractive and diffractive\u0026mdash;contralaterally along with cataract surgery.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e CNWT provides an almost full range of vision, as it achieves an average visual acuity of better than LogMAR 0.1 within the defocus curve range of +\u0026thinsp;0.5D to -3.0D.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Despite advancements in biometric measurements and IOL formulas, postoperative refractive surprises can still occur. Therefore, we prefer the mix and match approach, targeting minimal myopia for CNWT due to its strengths in intermediate and near vision, and minimal hyperopia for the other eye with a refractive type or extended depth of focus IOL, owing to its relatively better contrast sensitivity function for distance vision, to minimize the need for glasses.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e However, high satisfaction rates have also been reported in cases where TFNT was implanted in both eyes.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eRefractive stability is a crucial factor in visual prognosis. Observations over a year after Clareon monofocal IOL implantation revealed an SE change of approximately 0.1D. Similarly, our results obtained via CNWT on the same platform revealed a\u0026thinsp;+\u0026thinsp;0.07D shift, demonstrating very stable refractive power.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e In the toric IOL patients, the change in the refractive cylinder did not significantly differ during the examination period, and 88.02% of the patients were within \u0026minus;\u0026thinsp;0.75 D after one year, indicating very high refractive predictability and stability. Schartm\u0026uuml;ller et al. reported high rotational stability, observing an average rotation of 1.4\u0026deg; for six months after the implantation of toric Clareon monofocal IOLs.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Walters et al. reported an average rotation of 2.27\u0026deg; and an average change of less than 1\u0026deg; between one month and six months postoperatively.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e In this study, IOL rotation was not directly confirmed in all eyes; instead, eyes with visual acuity less than 0.8 or symptoms of blurry vision were investigated. A total of 0.62% of the eyes had an average IOL rotation of 27\u0026deg;, which required axis repositioning. Long axial length, C-loop design, and large dimensions of the capsular bag are known risk factors for rotation.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e In this study, rotation also associated with similar conditions.\u003c/p\u003e \u003cp\u003eAlthough IOL rotation did not occur, axis repositioning was performed in 1.56% of cases because of residual astigmatism. In most cases, the corneal cylinder axis changed between the preoperative and postoperative examinations. These variations are often observed in eyes with dry eye symptoms and an irregular corneal surface on the topography map or when the axis of the corneal cylinder changes during surgery.\u003c/p\u003e \u003cp\u003eAddressing dissatisfaction and reducing the rate of reoperation due to refractive surprises is crucial in IOL implantation. In this study, patients with unsatisfactory visual acuity were restored to normal by adjusting the IOL power, highlighting the necessity of improved biometric measurements, lens constant optimization and IOL formulas for the success of multifocal IOL implantation. Both Argos and IOLmaster700, which use swept-source OCT, exhibit high success rates in measuring axial length. Although several studies have shown differences in biometric values between the two devices, they are known to have a high correlation.\u003csup\u003e\u003cspan additionalcitationids=\"CR24 CR25 CR26\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e The IOLmaster700 measures axial length in the conventional way via a single equivalent refractive index, which results in an increased error as the axial length deviates from the average.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e In contrast, the K value is obtained by measuring the posterior cornea with swept-source OCT, providing a total K. Argos is more accurate in cases of long or short axial lengths because of its use of segmented axial length measurements.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e On the other hand, the K value uses the conventional method of the anterior corneal radius, which may result in lower accuracy than the IOLmaster700. Therefore, applying the same IOL constant to a different biometer may be associated with refractive surprise, making constant optimization essential. Additionally, since existing IOL formulas are based on data measured with a single equivalent refractive index, it seems necessary to develop a formula for the devices using segmented refractive index.\u003c/p\u003e \u003cp\u003eHowever, the errors were discovered in unexpected areas. In 15 eyes where the IOL was exchanged due to hyperopia, the prediction error of the IOLmaster 700 was greater than that of the Argos. These cases were developed by the surgeon who preferred the IOLmaster700. The device yielded warning signs for LT values, but the Barrett universal II formula was used regardless. Upon review, it was found that lens thickness was underestimated in all these cases. As a result, the effective lens position was predicted to be closer to the cornea, likely leading to a lower required IOL power. Since there is no function to correct this in the IOLmaster 700, third-generation IOL formulas that do not utilize LT are safer. Conversely, Argos had no issues with LT measurement and allows for manual adjustments if needed.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eLeveraging insights from our clinical experience with TFNT and CNWT implantation, we observed that discomfort increased when the UCDVA was below LogMAR 0.1 or when the UCNVA was below LogMAR 0.2. Proactive IOL exchanges with patient consent led to improved vision. These findings highlight the importance of further advancements in biometric measurements and IOL formulas. In particular, 66.67% of IOL exchanges were due to hyperopia, with the results of the IOLmaster 700 contributing significantly, highlighting the importance of selecting the right biometer. Conversely, reoperation due to myopia was not significantly different between the IOLmaster 700 and Argos groups. Previous studies comparing the two biometers have reported their outcomes using relatively small sample sizes and comparing means and standard deviations.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e,\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e While this statistical approach is suitable for explaining average cases, it has limitations in explaining extreme cases. Our results, which were based on a larger sample size, showed partial differences compared with those of previous studies. However, detailed analysis results will be presented in a separate paper, as they fall beyond the scope of this study.\u003c/p\u003e \u003cp\u003eThe frequency of PCO did not differ between monofocal IOLs made of Clareon and Acrysoft materials, and the square design of both IOLs slows the occurrence of PCO.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e However, Shah et al. reported that the frequency of posterior capsulotomy was greater for Acrysoft multifocal lenses than for monofocal lenses on the same platform. They noted that capsulotomy was performed to treat decreased vision after an average of 8.8 months in the multifocal lens group and 10.4 months in the monofocal lens group.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e Lee et al. reported that performing capsulotomy within a year after the implantation of a single-piece foldable hydrophobic acrylic IOL (SN60AT, Alcon, Fort Worth, TX, USA) tends to be associated with a hyperopic shift.\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e However, our study did not reveal a significant difference in refractive power before and after Nd:YAG laser treatment. Factors such as the size of the capsulotomy, the size of the CCC, and the capsular polishing technique might have influenced this outcome, although additional research is needed to confirm this.\u003c/p\u003e \u003cp\u003eThe glistening of the TFNT does not affect Snellen visual acuity and the defocus curve but is known to reduce contrast sensitivity and increase subjective photic phenomena.\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e Oshika et al. and Hugo et al. reported that in their respective follow-up studies at one year (384 eyes) and three years (191 eyes) after the implantation of monofocal IOLs made of the same material as CNWT, no glistening was observed.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e In our study, there were no cases of glistening. Considering the characteristics of multifocal IOLs, which divide light, resolving the glistening issue is naturally very beneficial for maintaining visual function.\u003c/p\u003e \u003cp\u003eA limitation of this study is that it is a single-center, single-arm study, which means that there was no control group for evaluating the superiority of IOL functions. Additionally, being a retrospective study, it can identify statistically significant correlations but cannot explain causal relationships. The outcomes for the CNWT reflect unilateral implantation in a mix-and-match context, not bilateral use. Furthermore, surgeon-specific device use for IOL power calculation introduces variability not representative of a standardized protocol. UCIVA was measured intermittently during the observation period, which is another limitation. However, the surgeries were performed by two physicians in similar environments, with more than 1,200 cases being consecutively enrolled and examined. Two experienced optometrists conducted the examinations to ensure the accuracy of the results. Moreover, only the results of visual acuity and refraction that were continuously measured during the observation period were analyzed. Therefore, this study is believed to serve as an appropriate guide for clinicians intending to understand the clinical outcomes of using the CNWT in a mix-and-match setting.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe new hydrophobic acrylic trifocal IOL (CNWT) with HEMA demonstrated significant improvements in visual acuity and refractive outcomes within one year in a mix-and-match setting, with minimal reoperations needed. The use of toric IOLs effectively reduced astigmatism. These findings highlight this IOL as a reliable option for enhancing visual quality and reducing dependency on spectacles in this specific context. However, despite the low rate of reoperations, further advancements in biometry and IOL formulas are necessary to reduce them even further. The intermittent measurement of UCIVA is a limitation of this study.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv id=\"AGS1\" class=\"AbbreviationGroupSection\"\u003e \u003cdiv class=\"Heading\"\u003eand Acronyms\u003c/div\u003e \u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUCDVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003euncorrected distance visual acuity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCDVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecorrected distance visual acuity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUCNVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003euncorrected near visual acuity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUCIVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003euncorrected intermediate visual acuity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHOA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehigh-order aberrations\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIOL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eintraocular lens\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHEMA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehydroxyethyl methacrylate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePEMA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ephenylethyl methacrylate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003estandard deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003espherical equivalent\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSph\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSpherical\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate: This study was approved by Ethics Committee (FSEC-20211-HR-009-01) of the First Samsung Eye Clinic, and it conformed to the tenets of the Declaration of Helsinki. Before surgery, written informed consent was obtained from all subjects.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting interest: The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Alcon Research LLC, Fort Worth, TX, USA, and Alcon Korea Ltd., Seoul, South Korea (Grand ID 89017199). The funding organization had no role in the design or conduct of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eS Choi and Y Choi contributed equally to this work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u0026nbsp;\u003c/strong\u003eS Choi and Y Choi participated in the study design, data analysis and interpretation, and manuscript writing. D Nam and S Na were involved in data collection. All authors reviewed this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGarc\u0026iacute;a-P\u0026eacute;rez JL, Gros-Otero J, S\u0026aacute;nchez-Ramos C, Bl\u0026aacute;zquez V, Contreras I. Short term visual outcomes of a new trifocal intraocular lens. 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BMC Ophthalmol. 2024;24(1):86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12886-024-03355-3\u003c/span\u003e\u003cspan address=\"10.1186/s12886-024-03355-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee YW, Choi CY, Moon K, et al. Clinical outcomes of new multifocal intraocular lenses with hydroxyethyl methacrylate and comparative results of contrast sensitivity, objective scatter, and subjective photic phenomena. BMC Ophthalmol. 2022;22(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12886-022-02600-x\u003c/span\u003e\u003cspan address=\"10.1186/s12886-022-02600-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHugo B, Emilie A, J\u0026eacute;r\u0026eacute;my B, et al. Long-term real-life outcomes of the Clareon\u0026reg; hydrophobic intraocular lens: the Clarte study in 191 eyes: 3-years real-life outcomes of the Clareon\u0026reg; intraocular lens. BMC Ophthalmol. 2024;24(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12886-024-03393-x\u003c/span\u003e\u003cspan address=\"10.1186/s12886-024-03393-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"glistening free, trifocal IOL","lastPublishedDoi":"10.21203/rs.3.rs-6088723/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6088723/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePURPOSE\u003c/h2\u003e \u003cp\u003eThe Clareon PanOptix (CNWT) IOL is a newer trifocal IOL made from a glistening-free hydrophobic acrylic material incorporating hydroxyethyl methacrylate (HEMA). While its predecessor (TFNT) has established clinical outcomes, long-term data. This study aimed to evaluate the refractive and visual outcomes during a 1-year follow-up after CNWT implantation in one eye, with a different type of refractive multifocal or extended depth of focus IOL in the contralateral eye (mix- and match setting).\u003c/p\u003e\u003ch2\u003eMETHOD\u003c/h2\u003e \u003cp\u003eThis was a retrospective, single-arm case series conducted at the single eye clinic, Seoul, Republic of Korea. The study included patients who underwent cataract surgery with mix-and-match IOL implantations, receiving a CNWT in one eye. Data were collected from the eyes with a CNWT. Monocular uncorrected distance visual acuity (UCDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UCNVA), and manifest refraction were analyzed from measurements taken at 1, 3, 6, and 12 months postoperatively. Rates and causes of secondary surgical intervention, such as IOL exchange and toric IOL axis readjustment, were also investigated. Statistical analysis involved Kolmogorov-Smirnov tests for normality and t-tests for comparisons, with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered significant.\u003c/p\u003e\u003ch2\u003eRESULTS\u003c/h2\u003e \u003cp\u003eData from 897 eyes (out of 1282 initially screened) with continuous measurements and no secondary interventional surgeries were included in the primary monocular visual acuity and refractive analysis. UCDVA of LogMAR 0.0 or better increased from 50.91% at 1 month to 85.95% at 12 months. CDVA of LogMAR 0.0 or better improved from 89.52% at 1 month to 98.1% at 12 months. At 12 months, 94.09% of eyes achieved UCNVA of LogMAR 0.1 or better. A slight mean hyperopic shift (+\u0026thinsp;0.07D) was observed up to 12 months. Toric CNWT IOLs were used in 71.0% of these eyes, with 88.07% achieving manifest refractive astigmatism of \u0026le; -0.75D at 12 months. Overall, 85 out of 1282 eyes (6.63%) underwent secondary surgery: 4.45% for IOL exchange and 2.18% for toric IOL axis readjustment. Post-reoperation, UCDVA and UCNVA significantly improved.\u003c/p\u003e\u003ch2\u003eCONCLUSIONS\u003c/h2\u003e \u003cp\u003eThe new hydrophobic acrylic trifocal IOL (CNWT) with HEMA demonstrated significant improvements in visual acuity and stable refractive outcomes over one year in a mix-and-match setting. The use of toric CNWT IOLs effectively reduced astigmatism. These findings suggest that this IOL is a reliable option for enhancing visual quality and reducing spectacle dependency in this specific implantation context. Despite the low rate of reoperations, the results underscore the ongoing need for advancements in biometric measurements and IOL power calculation formulas to further minimize such interventions.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eRetrospectively registered. This study was approved by the Institutional Review Board of First Samsung Eye Clinic (No. FSEC202311HR00901, approved November 2023).\u003c/p\u003e","manuscriptTitle":"Clinical Outcomes of Trifocal Intraocular Lens with Glistening-Free Hydrophobic Acrylic: A One-Year Follow-Up Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-15 02:22:33","doi":"10.21203/rs.3.rs-6088723/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-05T03:10:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-02T17:44:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-28T01:10:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2025-05-26T04:04:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"231017587174504680077271598950313994804","date":"2025-05-15T22:46:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-13T07:18:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-12T14:55:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2025-05-11T04:56:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fbfe53b4-7c8b-4698-8ee8-235a847a6e75","owner":[],"postedDate":"May 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:05:02+00:00","versionOfRecord":{"articleIdentity":"rs-6088723","link":"https://doi.org/10.1186/s12886-025-04198-2","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2025-07-01 15:58:02","publishedOnDateReadable":"July 1st, 2025"},"versionCreatedAt":"2025-05-15 02:22:33","video":"","vorDoi":"10.1186/s12886-025-04198-2","vorDoiUrl":"https://doi.org/10.1186/s12886-025-04198-2","workflowStages":[]},"version":"v1","identity":"rs-6088723","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6088723","identity":"rs-6088723","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}