Reasons for dissatisfaction after implantation of extended depth-of-focus and trifocal intraocular lenses: a retrospective case series

Background To analyze the adverse visual symptoms, underlying causes of dissatisfaction, and the effectiveness of subsequent interventions after implantation of extended depth-of-focus (EDOF) and trifocal IOLs. Methods This retrospective case series included 307 patients (390 eyes) who underwent phacoemulsification with presbyopia-correcting IOL implantation between January 2023 and July 2025. Patients were divided into an EDOF group (AcrySof IQ Vivity; 203 patients, 256 eyes) and a trifocal group (PanOptix TFNT00; 104 patients, 134 eyes). Eyes with postoperative dissatisfaction were analyzed. Visual acuity, refractive status, wavefront aberrations, ocular surface conditions, posterior capsule status, and fundus findings were evaluated. Causes of dissatisfaction and outcomes of interventions were assessed. Results Postoperative dissatisfaction occurred in 58 eyes (22.7%) in the EDOF group and 34 eyes (25.4%) in the trifocal group, with no significant difference between groups (χ² = 0.360, P = 0.548). Uncorrected distance visual acuity did not differ significantly between groups (P = 0.313), whereas uncorrected intermediate and near visual acuity were significantly better in the trifocal group (both P < 0.05). No significant intergroup differences were observed in postoperative visual quality index or total ocular aberrations, except for spherical aberration (P = 0.004). The primary causes of dissatisfaction were residual refractive errors, dry eye disease, posterior capsular opacification, and unmet visual expectations. After targeted interventions, most patients experienced symptomatic improvement. Conclusions Postoperative dissatisfaction after presbyopia-correcting IOL implantation is multifactorial and varies by IOL design. Individualized evaluation and tailored management strategies are essential to improve postoperative satisfaction.