Effect of Early-onset Posterior Capsule Opacification on Visual Outcomes in Trifocal Diffractive Pseudophakic Eyes: A Multicenter Prospective Study

Objective To elucidate the impact of early-onset PCO on the visual outcomes in patients with hydrophilic trifocal IOLs, and to ascertain the optimal timing for the application of Nd:YAG laser capsulotomy. Methods This is a prospective observational study. 189 patients implanted trifocal IOL who underwent Nd:YAG laser posterior capsulotomy were recruited. Patients were classified into four grades according to PCO morphology. The distance, intermediate, and near visual acuity (VA), dysfunction lens index (DLI), contrast sensitivity(CS) and visual function (VF-14) scores were measured before and 1 month after Nd:YAG laser capsulotomy. Results Before Nd:YAG laser capsulotomy, a significant correlation was observed between PCO grading and uncorrected distance (UDVA), intermediate (UIVA), near (UNVA) visual acuity, corrected distance VA (CDVA), DLI, and VF-14 scores (All P < 0.001). However, in patients with PCO grade 1 (early-onset), post-capsulotomy UNVA, DLI, medium and high spatial frequency contrast sensitivity under photopic condition and VF-14 scores were significantly improved compared with pre-capsulotomy values (all P < 0.05). The area under the receiver operating characteristic curve for DLI was 0.833 (P < 0.001), with a corresponding cut-off value of 7.28, indicating its usefulness in assessing the need for Nd:YAG laser capsulotomy in cases of early-onset PCO. Conclusions Early-onset PCO initially impairs near visual acuity in patients with trifocal IOLs and concurrently diminishes both subjective and objective of visual quality. DLI can effectively assess the severity of PCO, particularly in cases of early-onset PCO, and further determine the optimal timing for Nd:YAG laser capsulotomy.