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J Cataract Refract Surg. 2009 Dec;35(12):2136-43. doi: 10.1016/j.jcrs.2009.07.014.

Dual intraocular lens implantation: Monofocal lens in the bag and additional diffractive multifocal lens in the sulcus.

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  • 1Augenklinik am Neumarkt, Köln, Germany.



To evaluate a new diffractive multifocal intraocular lens (IOL) as an additional (add-on) IOL for sulcus-based implantation.


Augenklinik am Neumarkt, Köln, Germany.


In this prospective study, cataract patients had phacoemulsification and IOL implantation. After phacoemulsification, an aspheric silicone monofocal IOL (MS 612 ASP-Y) with a power range of +4.00 to +27.00 diopters [D]) was implanted in the capsular bag. This was followed by sulcus placement of an add-on multifocal IOL (MS 714 PB) with a +3.50 D diffractive element for near but zero refractive power for distance.


The study included 56 eyes of 30 patients. Three months postoperatively, the mean monocular uncorrected distance visual acuity was 0.10 logMAR +/- 0.11 (SD) (median 1.00 decimal; 20/20 Snellen), with a remaining mean postoperative spherical equivalent of 0.01 +/- 0.51 D. The mean uncorrected intermediate visual acuity was 0.20 +/- 0.15 logMAR (median 0.63 decimal; 20/30 Snellen) with a luminance of 500 lux at 1 m. The mean uncorrected near visual acuity (Early Treatment Diabetic Retinopathy chart) was 0.16 +/- 0.13 logMAR (median 0.80 decimal; Jaeger 2). No major complications (eg, iris chafing, iris capture, lens epithelial cell ingrowth, glaucoma) were associated with the add-on IOL in the sulcus.


Combined implantation of an add-on diffractive sulcus IOL and a monofocal capsular bag IOL was safe and effective in improving far and near visual acuity in cataract surgery. Preliminary visual acuity results were similar to those in eyes with a single 1-piece diffractive multifocal IOL.

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