Visual Outcomes and Patient-Reported Dysphotopsia After PanOptix and PanOptix Toric Implantation Stratified by Preoperative Chord Mu: A Prospective Observational Cohort Study

Abstract

We aimed to evaluate the tolerance of preoperative chord mu (angle kappa) after cataract or clear lens exchange surgery and implantation of AcrySof IQ PanOptix and PanOptix Toric in a Chinese cohort. This prospective observational study consecutively enrolled patients undergoing PanOptix/PanOptix Toric implantation at Peking Union Medical College Hospital. Eyes were analyzed by chord mu (< 0.3 mm vs. ≥ 0.3 mm), lens opacity (clear lens or cataract), and intraocular lens (PanOptix or PanOptix Toric). Visual acuity was assessed at 1 and 3 months. Patient-reported outcomes were assessed at 3 months using the IOLSAT and the QUVID. A total of 122 eyes from 62 patients were analyzed. Seventy-nine eyes received PanOptix Toric lenses, and 43 eyes received non-toric PanOptix lenses. The κ ≥ 0.3 mm group had less myopic spherical equivalent ( P = 0.004) than the κ < 0.3 mm group. At 1 and 3 months, the uncorrected and corrected distance, intermediate, and near visual acuity outcomes were excellent and did not differ significantly between κ groups in the overall cohort (all P > 0.05). In the toric subgroup,1-m UNVA was better in eyes with κ < 0.3 mm ( P < 0.001, adj. P = 0.024) than in those with κ ≥ 0.3 mm. Overall spectacle independence was 90% (45/50), with 100% for distance and intermediate vision in both κ groups; near spectacle independence was similar between groups ( P = 0.797). The most frequent visual disturbances were halos (78%, 39/50), starbursts (60%, 30/50), and glare (42%, 21/50), with no significant differences between the κ groups (all P > 0.05). Patient-reported outcomes and disturbance frequencies were similar between PanOptix and PanOptix Toric (all P > 0.05). Compared with cataract surgery, clear lens exchange resulted in increased rates of halos (92.3% vs. 62.5%, P = 0.016). In this carefully selected, small sample Chinese cohort implanted with PanOptix/PanOptix Toric lense and restricted to eyes with chord mu ≤ 0.5 mm, a κ ≥ 0.3 mm was not associated with worse overall visual acuity, spectacle independence, or the likelihood/severity of visual disturbances. The PanOptix Toric lens demonstrated patient-reported outcomes comparable to those of the non-toric PanOptix. Patients who underwent clear lens exchange reported more visual disturbances than those who underwent cataract surgery, suggesting a need for careful candidate selection and preoperative counseling.