title: Dissatisfaction after multifocal intraocular lens implantation.
abstract: OBJECTIVE
  To analyze the reasons for patient dissatisfaction after phacoemulsification with multifocal intraocular lens (IOL) implantation and the outcomes after intervention.
  
  
  METHODS
  Emory Eye Center, Atlanta, Georgia, USA.
  
  
  METHODS
  This retrospective review comprised eyes of patients dissatisfied with visual outcomes after multifocal IOL implantation. Outcomes analyzed included type of visual complaint, treatment modality for each complaint, and degree of clinical improvement after intervention.
  
  
  RESULTS
  Thirty-two patients (43 eyes) reported unwanted visual symptoms after multifocal IOL implantation, including in 28 eyes (65%) with an AcrySof ReSTOR IOL and 15 (35%) with a ReZoom IOL. Thirty patients (41 eyes) reported blurred vision, 15 (18 eyes) reported photic phenomena, and 13 (16 eyes) reported both. Causes of blurred vision included ametropia (12 eyes, 29%), dry eye syndrome (6 eyes, 15%), posterior capsule opacification (PCO) (22 eyes, 54%), and unexplained etiology (1 eye, 2%). Causes of photic phenomena included IOL decentration (2 eyes, 12%), retained lens fragment (1 eye, 6%), PCO (12 eyes, 66%), dry-eye syndrome (1 eye, 2%), and unexplained etiology (2 eyes, 11%). Photic phenomena attributed to PCO also caused blurred vision. Thirty-five eyes (81%) had improvement with conservative treatment. Five eyes (12%) did not have improvement despite treatment combinations. Three eyes (7%) required IOL exchange.
  
  
  CONCLUSIONS
  Complaints of blurred vision and photic phenomena after multifocal IOL implantation were effectively managed with appropriate treatment. Few eyes (7%) required IOL exchange. Neodymium:YAG capsulotomy should be delayed until it has been determined that IOL exchange will not be necessary.
authors.affiliation: Emory Eye Center and Emory Vision, Atlanta, Georgia, USA. mwoodwa@emory.edu
authors.forename: Maria A
authors.initials: MA
authors.lastname: Woodward
authors.forename: J Bradley
authors.initials: JB
authors.lastname: Randleman
authors.forename: R Doyle
authors.initials: RD
authors.lastname: Stulting
mesh_terms: D000368:Aged; D002386:Cataract / Q000209:etiology; D005260:Female; D006801:Humans; D007903:Lens Capsule, Crystalline / Q000473:pathology; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D018918:Phacoemulsification; D011183:Postoperative Complications; D012189:Retrospective Studies; D014786:Vision Disorders / Q000209:etiology*; D014792:Visual Acuity / Q000502:physiology