OBJECTIVES: Multifocal IOLs are indicated for the correction of presbyopia alongside cataract surgery and could provide greater improvement in visual outcomes than monofocal IOLs. However, multifocal implantations can be associated with unexpected visual disturbances leading to dissatisfactory visual outcomes necessitating lens explantation and consequently exchange with a new IOL. The objective of this systematic literature review was to report published lens explantation and exchange rates associated with multifocal IOLs.

METHODS: Embase, Cochrane and Medline databases were searched from inception to February 2018. English language studies reporting explantation and exchange rate in patients implanted with multifocals were included.

RESULTS: In an RCT study, the reported 12 month explantation and exchange rate for multifocal vs. monofocal IOLs was 5.7% and 0.0% respectively; in all affected patients the exchanged lens was monofocal. In another RCT study, the reported 3 month explantation and exchange rate for multifocals vs. monofocals was 0.8% and 0.0% respectively; exchanged lens type was not reported. Two recently conducted RCTs with follow-up of 6-24 months reported 0% explantation rate for both multifocal and monofocal IOLs. A comparative prospective observational study reported a 12 month rate of 1.4% for multifocal explantation and exchange vs. 0.0% for monofocal IOLs. In this study, all affected patients were implanted monofocal IOL as exchanged lens. Further, we identified six RCTs reporting explantation and exchange rates with different multifocal IOL models at follow-up time-points between 7 days and 6 months. The reported multifocal explantation and exchange rates were between 0.0% and 4%; type of exchanged IOL (monofocal) was reported only in one study.

CONCLUSIONS: Limited evidence suggests that multifocal could be associated with a higher explantation and lens exchange rates vs. monofocal IOLs. The data is inconsistently reported across studies and requires better reporting in future studies.