Cataract surgery is among the most commonly performed and most successful procedures
worldwide, yet visual outcomes do not always meet expectations. Even after uneventful
surgery, postoperative visual quality may be compromised due to residual refractive
errors, tear film instability, or microstructural changes in the IOL material such as
glistenings. This thesis aimed to investigate two specific aspects related to visual
performance in pseudophakic eyes.
In the first study, we analyzed 42 eyes of 51 patients implanted with either AcrySof
IQ or Z-Flex hydrophobic acrylic IOLs. Glistenings were assessed using both
semiquantitative slit-lamp grading and computer-assisted Scheimpflug image analysis. A
strong correlation was found between subjective grading and objective measurements (r
= 0.81, p < 0.001). Although glistenings were more pronounced in the AcrySof IQ group
(mean score: 3.2 vs. 1.7, p < 0.01), visual acuity and contrast sensitivity did not differ
significantly between the groups. However, the tear film–related scatter index (TF-OSI)
was significantly higher in the Z-Flex group (2.65 ± 0.81 vs. 1.92 ± 0.65; p = 0.004),
indicating that tear film quality may offset the potential optical benefits of reduced
glistenings.
The second study focused on the clinical outcomes of secondary implantation of
the 1stQ AddOn IOL in the ciliary sulcus for the correction of pseudophakic ametropia.
Fourteen eyes of 12 patients were followed for a mean of 34.3 ± 16.1 months. Uncorrected
visual acuity improved significantly (from 0.42 to 0.81 on the decimal scale), and the
lenses remained stable without complications such as elevated intraocular pressure,
pigment dispersion, or endothelial cell loss.
In conclusion, our findings underscore the importance of both IOL material
properties and ocular surface quality in determining postoperative visual performance.
Supplementary IOL implantation in the sulcus offers a safe and effective solution for
residual refractive errors, providing a minimally invasive alternative to IOL exchange and
contributing to improved patient satisfaction.
