Chan Hong Min; Jaehyuck Jo; Ho Seok Chung; Dong Yoon Kim; Jin Hyoung Park

doi:10.63375/icrs.26.001

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Original Article
Clinical outcomes of combined phacoemulsification and epiretinal membrane peeling using three advanced intraocular lens platforms: Chan Hong Min¹, Jaehyuck Jo¹, Ho Seok Chung^2,3, Dong Yoon Kim⁴, Jin Hyoung Park^1,3; DOI: https://doi.org/10.63375/icrs.26.001
Published online: May 21, 2026

¹MS Eye Clinic, Seoul, Korea

²Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

³Research Institute for Biomacromolecules, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

⁴Top Retina Center, Cheongju, Korea

Correspondence to: Jin Hyoung Park MS Eye Clinic, 189 Sinbanpo-ro, Seocho-gu, Seoul 06512, Korea Tel: +82-2-6949-3322E-mail: drpark99@naver.com

• Received: February 15, 2026 • Revised: April 8, 2026 • Accepted: April 8, 2026

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
Introduction
Methods
Results
Discussion
Article Information
References

Abstract

Purpose
This retrospective study evaluated the clinical outcomes of combined phacoemulsification, implantation of 1 of 3 types of advanced intraocular lenses (IOLs) with multifocality, and pars plana vitrectomy with epiretinal membrane (ERM) peeling in patients with cataract and ERM. Outcomes were compared with those in age-matched controls who underwent phacoemulsification with the same IOL alone.
Methods
A total of 70 eyes were included: 35 eyes underwent combined surgery, and 35 served as controls. In each group, 15 eyes received an advanced monofocal IOL (Tecnis Eyhance ICB00), 15 received a hybrid diffractive extended-depth-of-focus (EDoF) IOL (Tecnis Symfony ZXR00), and five received a hybrid refractive EDoF IOL (Precizon Presbyopic NVA).
Results
All groups showed significant visual improvement by 6 months postoperatively. Eyes that received hybrid diffractive EDoF IOLs and underwent combined surgery showed significantly worse mean corrected distance visual acuity, uncorrected distance visual acuity, corrected intermediate visual acuity, and corrected near visual acuity at 3 months than control eyes, but these outcomes improved to levels comparable to those of control eyes by 6 months. Eyes that received hybrid refractive EDoF IOLs showed similar early delays; however, interpretation was limited by the small sample size.
Conclusion
Overall, combined surgery was safe and effective, although early visual recovery may be delayed in eyes receiving EDoF IOLs. These findings suggest that advanced monofocal and EDoF IOLs may be considered in selected patients with ERM; however, the results should be interpreted cautiously because of the retrospective design and limited sample size.
Keywords: Cataract; Epiretinal membrane; Lenses, intraocular; Advanced monofocal intraocular lens; Extended depth of focus intraocular lens

Introduction

The combination of cataract surgery and advanced intraocular lens (IOL) insertion has become a widely accepted and highly effective method for restoring vision in individuals with cataract. The introduction of advanced IOLs with multifocality has significantly broadened the treatment options, giving patients a wide field of functional vision from intermediate to far distances [1,2]. Advanced monofocal and extended-depth-of-focus (EDoF) IOLs have been recognized for their capacity to provide a continuous range of focus, which helps minimize visual disturbances, such as halos and glare, which are commonly associated with traditional multifocal IOLs [1,3-6].

As the number of older adults continues to grow, the prevalence of retinal diseases such as epiretinal membrane (ERM) also increases, often concomitant with cataract [7-9]. ERM is characterized by the formation of a thin fibrous membrane on the surface of the macula, resulting in distorted vision and diminished visual acuity [10]. The juxtaposition of cataract and ERM presents a challenge for ophthalmologists, as conventional multifocal IOLs may not be suitable for patients with macular pathology [11,12]. Advanced monofocal and EDoF IOLs, however, are more tolerant of dysphotopsia and contrast sensitivity loss than conventional multifocal IOLs, making them a better option for patients seeking comfortable visual outcomes and improved quality of life [1,3-6]. Recent studies have demonstrated that advanced monofocal and EDoF IOLs are effective in patients with mild-to-moderate ERM, providing improved overall visual outcomes, albeit with limited improvement in intermediate distance vision [13,14].

Despite these advancements, the comparative performance of different types of advanced IOLs, particularly designs with distinct optical principles, remain insufficiently understood in eyes with ERM. The Tecnis Eyhance (advanced monofocal IOL), the Tecnis Symfony (hybrid diffractive EDoF), and the Precizon Presbyopic NVA (hybrid refractive EDoF) represent three categories of contemporary designs with distinct optical properties. Because each lens employs a different mechanism to extend the range of focus, their postoperative recovery may differ in eyes undergoing ERM peeling. Because ERM disrupts retinal architecture and delays postoperative visual recovery, it is plausible that IOLs requiring greater neural adaptation, particularly diffractive or refractive EDoF lenses, may show different recovery patterns compared with advanced monofocal lenses.

This study evaluated the safety, clinical predictability, and recovery of vision associated with cataract surgery using these three different types of IOLs in patients with ERM, by measuring visual and refractive outcomes, foveal thickness, and the occurrence of dysphotopsia. The study also aimed to elucidate the relative advantages and limitations of these three advanced IOL designs in the presence of macular pathology.

Methods

Ethics statement

This study was a retrospective, non-randomized, comparative clinical study conducted at MS Eye Clinic in Seoul, Korea, approved by the Public Institutional Bioethics Committee designated by the MOHW (No. P01-202506-01-010), and performed in accordance with the principles of the Declaration of Helsinki. The need for informed consent was waived due to the retrospective nature of the study.

Study design and participants

The study included 70 eyes (70 patients), of which 35 underwent a combined surgical procedure consisting of phacoemulsification, advanced monofocal or EDoF IOL implantation, pars plana vitrectomy (PPV) and ERM peeling (combined surgery group). The other 35 eyes underwent phacoemulsification and advanced monofocal or EDoF IOL implantation without PPV and ERM peeling (control group). The included patients had undergone the combination surgery between December 2018 and March 2022 and were followed up for at least 6 months after surgery. Eyes with additional macular diseases (e.g., macular hole, age-related macular degeneration), severe ocular surface disease, or significant corneal astigmatism were excluded.

No formal sample size calculation was performed due to the retrospective nature of the study. The study should therefore be considered exploratory, particularly for subgroup comparisons.

Intraocular lenses

Three types of IOLs with distinct optical designs were implanted in this study: the Tecnis Eyhance ICB00 (Johnson & Johnson), the Tecnis Symfony ZXR00 (Johnson & Johnson), and the Precizon Presbyopic NVA (Ophtec B.V.).

The Tecnis Eyhance ICB00 is an aspheric monofocal IOL designed to provide enhanced intermediate visual performance while maintaining the optical clarity and low photic phenomena of a standard monofocal lens. The optic incorporates a continuous power profile with a subtle increase in central curvature, extending the depth of focus without the use of diffractive elements.

The Tecnis Symfony ZXR00 utilizes a patented echelette-type diffractive design to generate a continuous range of focus rather than multiple focal points. The diffractive pattern also incorporates chromatic aberration correction, which enhances contrast sensitivity and reduces halo formation compared with traditional multifocal IOLs. This IOL is intended to provide EDoF from distance to intermediate ranges while minimizing photic symptoms.

The Precizon Presbyopic NVA is based on a unique hybrid refractive design characterized by multiple continuous transitional refractive zones that provide a smooth power shift across the optic. This architecture generates an extended range of focus and is less dependent on precise centration than traditional multifocal designs.

Age-matched controls who underwent phacoemulsification with advanced IOL with multifocality implantation without ERM peeling were also included for comparison. Visual outcomes and foveal thickness were compared among the eyes in the combined surgery group according to the implanted IOL type.

Distribution of IOL types was as follows: (1) Tecnis Eyhance ICB00 (advanced monofocal IOL): 15 ERM eyes, 15 controls; (2) Tecnis Symfony ZXR00 (hybrid diffractive EDoF IOL): 15 ERM eyes, 15 controls; and (3) Precizon Presbyopic NVA (hybrid refractive EDoF IOL): five ERM eyes, five controls.

ERM classification

ERM severity was classified using structural spectral-domain optical coherence tomography (SD-OCT) characteristics. Four stages were defined based on the degree of foveal distortion and retinal layer integrity. Stage 1 was characterized by a thin ERM with preservation of the normal foveal contour and clearly distinguishable retinal layers. Stage 2 showed loss of the typical foveal depression with early thickening of the outer retinal layers, while the overall lamination of the retina remained intact. Stage 3 was defined by the presence of ectopic inner retinal tissue extending across the foveal area, although individual retinal layers could still be identified. Stage 4 represented advanced disease, with a markedly thickened membrane, disruption of macular architecture, indistinct retinal layers, and continuous ectopic inner foveal tissue. For this study, only eyes with Stage 1 or Stage 2 ERM were included.

Surgical technique

The study cohort included patients who underwent combination phacoemulsification, advanced IOL with multifocality implantation, and PPV with ERM peeling surgery for the treatment of cataract with ERM. During PPV with ERM peeling, a standard 25-gauge PPV was performed using the Constellation Vision System (Alcon Laboratories) under a non-contact wide-angle viewing system (BIOM, Oculus). After core vitrectomy and posterior hyaloid detachment as needed, membrane peeling was carried out using conventional techniques, and the internal limiting membrane (ILM) was removed with the assistance of indocyanine green dye diluted in 5% dextrose solution. All surgeries were performed by a single vitreoretinal surgeon (JHP).

Data collection and outcome measures

Demographic data, including age and sex, were gathered for all patients. Preoperative examinations were performed prior to surgery, and postoperative examinations were performed at 3 and 6 months. Foveal thickness was measured using OCT (Canon OCT-HS100, Canon). Foveal thickness was defined as the distance from the retinal pigment epithelium to the ILM at the point of maximal foveal height. Measurements were performed using SD-OCT software (Rx Capture ver. 4.4.0.11) with the integrated caliper tool.

Distance (5 m), intermediate (66 cm), and near (33 cm) visual acuity were measured. Corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), corrected intermediate visual acuity (CIVA), and corrected near visual acuity (CNVA) were obtained. Distance visual acuity was measured using Hahn’s standard test chart, and intermediate visual acuity and near visual acuity were measured using a Jaeger standard test chart under photopic conditions (>85 cd/m²). CIVA was not assessed preoperatively and was therefore not included in baseline comparisons. All visual acuity measurements were performed monocularly and were converted to logarithm of the minimal angle of resolution values for statistical analyses. A monocular defocus curve was obtained 6 months postoperatively. After achieving distance correction at 5 m, visual acuity was assessed from −3.5 diopter (D) to +2.0 D in 0.5 D increments using trial lenses.

At each postoperative visit, patients were questioned regarding the presence of metamorphopsia, visual distortion, or dysphotopsia symptoms, including halo, flicker, and glare.

Statistical analysis

Statistical analyses were performed using the appropriate methods to compare the clinical outcomes between the combined surgery and control groups. Continuous variables were expressed as mean±standard deviation or median (range), and categorical variables were expressed as frequencies and percentages. The Mann-Whitney U test, paired t-test, and Kruskal-Wallis test were used to compare continuous variables, and chi-squared or Fisher exact test was used to compare categorical variables. Statistical analyses were conducted using IBM SPSS ver. 25.0 (IBM Corp.). A P-value <0.05 was considered statistically significant.

Results

Patient characteristics

The demographic characteristics, including age and sex, were similar between the combined surgery and control groups (Table 1). During the follow-up period, no significant postoperative complications, including cystoid macular edema, endophthalmitis, or hypotony, were reported. In addition, no clinically significant dysphotopsia or other adverse events related to the surgical procedures were reported in either the combined surgery or control group during the follow-up period.

Baseline demographic and clinical characteristics of the study population are summarized in Table 1. Eyes in the combined surgery group demonstrated greater preoperative foveal thickness and poor baseline visual acuity compared with control eyes, consistent with the presence of ERM.

Visual outcomes

Overall, all eyes demonstrated postoperative improvement in visual acuity following surgery. Changes in visual acuity, refractive outcomes, and foveal thickness are summarized in Tables 2 and 3. Baseline demographic and preoperative clinical characteristics were consolidated into Table 1 to avoid redundancy. Postoperative outcomes at 3 and 6 months are presented separately in Table 2.

At 3 months postoperatively, eyes implanted with hybrid diffractive EDoF IOLs and undergoing ERM peeling showed significantly poorer visual acuity outcomes compared with their corresponding control group. Specifically, mean CDVA, UDVA, CIVA, and CNVA were significantly poorer in the ERM peeling group (P<0.001, P=0.002, P=0.009, and P<0.001, respectively) (Table 2). Similarly, eyes implanted with hybrid refractive EDoF IOLs combined with ERM peeling demonstrated significantly inferior postoperative CDVA, UDVA, CIVA, and CNVA compared with controls at 3 months (P=0.042, P=0.049, P=0.007, and P=0.013, respectively).

In contrast, eyes in the control groups, undergoing phacoemulsification with advanced monofocal or EDoF IOL implantation without ERM peeling, exhibited significant improvements in UDVA, CDVA, and CNVA by 3 months postoperatively, which remained stable at 6 months. In the hybrid refractive EDoF control subgroup, however, improvements in UDVA and CNVA did not reach statistical significance.

By 6 months after surgery, visual acuity outcomes in both EDoF IOL groups with ERM peeling showed further improvement, and the differences in UDVA, CDVA, CIVA, and CNVA compared with their respective control groups were no longer statistically significant (Table 2).

Temporal changes in visual acuity within each IOL group are presented in Table 3. In the control groups, improvements in UDVA, CDVA, CNVA, and CIVA were achieved by 3 months postoperatively, with no significant additional gains thereafter. In contrast, eyes undergoing ERM peeling with EDoF IOL implantation demonstrated continued improvement between 3 and 6 months postoperatively. Significant gains during this interval were observed in CDVA, CIVA, and CNVA, particularly in the hybrid diffractive EDoF IOLs and hybrid refractive EDoF IOLs PPV subgroups (Table 3).

At 6 months postoperatively, no statistically significant differences were observed among the three IOL types within the ERM peeling groups in terms of UDVA, CDVA, CIVA, CNVA, or foveal thickness (P=0.183, P=0.885, P=0.575, P=0.308, and P=0.237, respectively) (Table 4).

Defocus curve analysis

Monocular defocus curves were obtained at 6 months postoperatively for each IOL type (Fig. 1). All three IOLs demonstrated comparable visual acuity at the distance focus (0.0 D), with no significant differences observed among the groups. Compared with the advanced monofocal IOL, both hybrid diffractive and hybrid refractive EDoF IOLs showed better visual performance at negative defocus levels corresponding to near vision. In particular, the EDoF IOL groups maintained relatively stable visual acuity across a broader range of defocus values, reflecting an EDoF in both the control and combined surgery groups.

Foveal thickness and anatomical changes

Foveal thickness measurements obtained using OCT showed a reduction in the combined surgery groups for all IOL types at 3 and 6 months after surgery (P=0.047 at 3 months, P<0.001 at 6 months compared to preoperative values). Despite this postoperative decrease, foveal thickness remained significantly greater in eyes undergoing combined surgery than in control eyes throughout the entire follow-up period (Table 2).

Discussion

The findings of this study highlight the safety, efficacy, and clinical predictability of combined phacoemulsification, advanced monofocal or EDoF IOL implantation, and PPV with ERM peeling surgery for patients with cataract and ERM. These results are especially pertinent in the context of an aging population, where cataract and retinal pathologies such as ERM frequently coexist [7-9]. Before delving into the stability of surgical outcomes, ensuring safety during surgery was a crucial consideration. Diffractive and refractive multifocal IOLs are known to interfere with the surgical view during PPV and ERM peeling [15,16]; however, subsequent studies have not reported difficulties in the surgical view with diffractive trifocal IOLs during ERM peeling [17]. Additionally, a study on EDoF IOLs during PPV reported clearer surgical views compared with multifocal IOLs [18]. Consistent with these reports, no intraoperative visualization difficulties were encountered in the present study, allowing safe membrane peeling and stable postoperative outcomes.

Visual outcomes, including CDVA, UDVA, CIVA, and CNVA, improved in all eyes at 6 months post-surgery. However, eyes implanted with hybrid diffractive and hybrid refractive EDoF IOLs demonstrated delayed visual recovery at 3 months compared with control eyes, particularly following combined surgery. This transient delay is likely attributable to the combined effects of postoperative retinal remodeling after ERM peeling and the greater dependence of EDoF IOLs on intact retinal architecture and neural adaptation. Previous reports have indicated that visual acuity recovery after ERM surgery extends beyond 3 months (approximately 3–4 months) with approximately 70% of retinal anatomy restored by 3 months [19,20]. In this context, differences in visual acuity between advanced monofocal and EDoF IOLs may become more apparent when retinal anatomical recovery is incomplete. Importantly, after retinal anatomy recovery had largely stabilized, visual acuity outcomes became comparable across IOL types by 6 months, although the study was not powered to confirm equivalence.

Defocus curves at the 6-month postoperative demonstrated comparable distance visual acuity across all three types of IOLs within the ERM surgery group; however, both hybrid diffractive and hybrid refractive EDoF IOLs showed better near vision compared with advanced monofocal IOLs. Significant differences were observed between advanced monofocal and each EDoF IOLs, whereas differences between the two EDoF IOLs were minimal, with only small disparity at higher negative defocus diopters. This shows the potential benefits of specific IOL designs in meeting specific visual needs. Additionally, there were no significant differences in postoperative spherical equivalent between the combined surgery and cataract-alone surgery groups, consistent with previous studies [21].

It should also be noted that advanced monofocal IOLs (Tecnis Eyhance ICB00) and hybrid diffractive EDoF IOLs (Tecnis Symfony ZXR00) share a common manufacturer platform, whereas hybrid refractive EDoF IOLs (Precizon Presbyopic NVA) are produced by a different manufacturer. Therefore, differences observed between groups may reflect not only optical design but also platform-specific characteristics. Additionally, another refractive EDoF IOL from the same manufacturer platform, Tecnis PureSee, was not included in this study because it was not available during the study period.

Several limitations should be acknowledged. First, due to the retrospective design, advanced monofocal and EDoF IOLs were preferentially implanted in patients with relatively early-stage ERM. Consequently, only eyes with stages 1 and 2 ERM were included, and no subgroup analysis according to ERM severity was performed. This limits a detailed assessment of baseline macular comparability and restricts the generalizability of the findings to more advanced ERM. Second, the small number of eyes in the hybrid refractive EDoF group reflects the relative frequency of this IOL implanted during the study period, rather than an intentional selection process. The small sample size in the hybrid refractive EDoF IOL group reduced the statistical power of comparisons involving this subgroup. Therefore, subgroup comparisons should be interpreted cautiously, and the present findings should be considered exploratory rather than confirmatory. Finally, contrast sensitivity and patient-reported visual quality were not evaluated using validated questionnaires, limiting a comprehensive assessment of visual quality trade-offs. Although no patients reported significant dysphotopsia, such as glare or halos, the absence of structured and standardized patient-reported outcome measures remains a limitation. Future studies incorporating validated questionnaires may provide more robust insights into subjective visual quality and dysphotopsia following combined surgery.

In conclusion, combined phacoemulsification, advanced IOL with multifocality implantation, and PPV with ERM peeling surgery appear to provide safe and clinically favorable outcomes in patients with mild ERM. Despite potential delays in visual recovery in eyes implanted with EDoF IOLs, particularly in the early postoperative period, outcomes at 6 months appeared comparable, although the study was not sufficiently powered to confirm equivalence. These findings suggest that advanced monofocal and EDoF IOLs may be considered in selected patients with ERM; however, the results should be interpreted cautiously due to the retrospective design and limited sample size.

Article Information

Author contributions

Conceptualization: JHP. Data curation: JHP. Formal analysis: CHM, JHP. Methodology: JHP. Project administration: JHP. Supervision: JHP. Writing – original draft: CHM, JJ, HSC, JHP. Writing – review & editing: all authors. Final approval of the manuscript: all authors.

Conflicts of interest

No potential conflict of interest relevant to this article was reported.

Funding

None.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Fig. 1.

Defocus curves of the three intraocular lens types at 6 months postoperatively. (A) Eyes that underwent pars plana vitrectomy with epiretinal membrane (ERM) peeling. (B) Control eyes. D, diopter; logMAR, logarithm of the minimum angle of resolution. ^a)Advanced monofocal intraocular lens (IOL) group; ^b)Hybrid diffractive extended-depth-of-focus (EDoF) IOL group; ^c)Hybrid refractive EDoF IOL.

Table 1.

Demographics and preoperative clinical characteristics of the study patients at baseline

Demographic	Eyhance^a)			Symfony^b)			Precizon^c)
Demographic	No PPV (n=15)	PPV (n=15)	P-value	No PPV (n=15)	PPV (n=15)	P-value	No PPV (n=5)	PPV (n=5)	P-value
Age (yr)	68.07±6.18	67.93±11.17	0.847	62.00±6.92	60.40±5.60	0.487	65.00±9.27	67.00±5.10	0.684
Sex, male/female	8/7	7/8	0.726	5/10	4/11	0.787	1/4	2/3	0.545
SE (D)	−0.40±1.81	−0.18±2.28	0.694	−1.52±4.42	−1.37±4.20	0.781	−0.85±1.38	0.75±0.85	0.014
Foveal thickness (µm)	263.00±18.45	360.50±80.82	<0.001	256.31±23.41	333.73±61.49	<0.001	273.40±17.42	396.00±36.55	0.009
UDVA (logMAR)	0.19±0.18	0.64±0.42	0.001	0.16±0.08	0.58±0.71	<0.001	0.18±0.09	0.28±0.08	0.100
CDVA (logMAR)	0.09±0.11	0.37±0.35	0.001	0.12±0.06	0.16±0.05	0.015	0.18±0.09	0.16±0.06	0.911
CNVA (logMAR)	0.62±0.23	0.62±0.25	0.733	0.60±0.21	0.61±0.18	0.678	0.52±0.18	0.76±0.15	0.054

Values are presented as mean±standard deviation. Visual acuity is expressed as logarithm of the minimum angle of resolution (logMAR).

PPV, pars plana vitrectomy; SE, spherical equivalent; D, diopter; UDVA, uncorrected distance visual acuity; CDVA, corrected distance visual acuity; CNVA, corrected near visual acuity.

^a)Advanced monofocal intraocular lens (IOL) group;

^b)Hybrid diffractive extended-depth-of-focus (EDoF) IOL group;

^c)Hybrid refractive EDoF IOL.

Table 2.

Postoperative visual acuity, refraction, and foveal thickness compared with controls

Variable	Eyhance^a)			Symfony^b)			Precizon^c)
Variable	No PPV (n=15)	PPV (n=15)	P-value	No PPV (n=15)	PPV (n=15)	P-value	No PPV (n=5)	PPV (n=5)	P-value
Postoperative 3 mo
SE (D)	−0.07±0.54	−0.13±0.52	0.824	−0.39±0.46	−0.40±0.66	0.614	−1.15±0.82	−0.80±0.87	0.343
Foveal thickness (µm)	268.27±19.52	354.29±70.82	<0.001	258.38±23.29	325.87±56.49	<0.001	270.40±13.47	379.80±29.74	0.009
UDVA (logMAR)	0.03±0.04	0.13±0.11	0.004	0.04±0.05	0.13±0.07	0.002	0.08±0.08	0.20±0.07	0.049
CDVA (logMAR)	0.01±0.03	0.02±0.04	0.258	0.02±0.04	0.11±0.06	<0.001	0.04±0.05	0.12±0.05	0.042
CIVA (logMAR)	0.14±0.09	0.18±0.08	0.186	0.12±0.09	0.22±0.09	0.009	0.16±0.06	0.36±0.05	0.007
CNVA (logMAR)	0.33±0.12	0.33±0.11	0.891	0.17±0.08	0.41±0.15	<0.001	0.28±0.15	0.69±0.18	0.013
Postoperative 6 mo
SE (D)	−0.10±0.43	−0.14±0.48	0.532	−0.38±0.46	−0.38±0.57	0.791	−1.15±0.80	−0.65±0.68	0.292
Foveal thickness (µm)	262.87±17.80	339.07±73.90	<0.001	260.19±20.93	311.47±49.84	<0.001	271.80±16.22	347.00±27.15	0.009
UDVA (logMAR)	0.04±0.05	0.07±0.10	0.422	0.04±0.06	0.05±0.06	0.890	0.10±0.10	0.14±0.11	0.588
CDVA (logMAR)	0.01±0.03	0.03±0.05	0.058	0.02±0.04	0.04±0.05	0.200	0.02±0.04	0.04±0.09	0.881
CIVA (logMAR)	0.15±0.11	0.15±0.08	0.691	0.08±0.08	0.13±0.05	0.054	0.16±0.09	0.16±0.06	0.817
CNVA (logMAR)	0.33±0.11	0.32±0.09	0.872	0.20±0.08	0.27±0.10	0.040	0.28±0.13	0.28±0.08	0.914

Values are presented as mean±standard deviation. Visual acuity is expressed as logarithm of the minimum angle of resolution (logMAR).

PPV, pars plana vitrectomy; SE, spherical equivalent; D, diopter; UDVA, uncorrected distance visual acuity; CDVA, corrected distance visual acuity; CIVA, corrected intermediate visual acuity; CNVA, corrected near visual acuity.

^a)Advanced monofocal intraocular lens (IOL) group;

^b)Hybrid diffractive extended-depth-of-focus (EDoF) IOL group;

^c)Hybrid refractive EDoF IOL.

Table 3.

Temporal changes in visual acuity within each intraocular lens group

Group	Time	Δ (95% CI)	P-value
Eyhance^a)
UDVA	Preop to 3 mo	0.15 (0.05 to 0.25)	0.005
	Preop to 6 mo	0.14 (0.04 to 0.24)	0.007
	3 mo to 6 mo	−0.01 (−0.03 to 0.01)	0.164
CDVA	Preop to 3 mo	0.08 (0.03 to 0.13)	0.003
	Preop to 6 mo	0.08 (0.03 to 0.13)	0.003
	3 mo to 6 mo	NA
CNVA	Preop to 3 mo	0.30 (0.15 to 0.46)	0.001
	Preop to 6 mo	0.30 (0.14 to 0.46)	0.001
	3 mo to 6 mo	0.00 (−0.02 to 0.02)	0.981
CIVA	3 mo to 6 mo	−0.01 (−0.03 to 0.02)	0.598
Eyhance (PPV)
UDVA	Preop to 3 mo	0.51 (0.27 to 0.76)	0.001
	Preop to 6 mo	0.57 (0.34 to 0.80)	<0.001
	3 mo to 6 mo	0.05 (0.00 to 0.11)	0.061
CDVA	Preop to 3 mo	0.35 (0.14 to 0.56)	0.003
	Preop to 6 mo	0.34 (0.14 to 0.53)	0.003
	3 mo to 6 mo	−0.01 (−0.03 to 0.01)	0.165
CNVA	Preop to 3 mo	0.29 (0.13 to 0.45)	0.002
	Preop to 6 mo	0.30 (0.14 to 0.46)	0.001
	3 mo to 6 mo	0.01 (−0.01 to 0.03)	0.165
CIVA	3 mo to 6 mo	0.03 (0.00 to 0.06)	0.040
Symfony^b)
UDVA	Preop to 3 mo	0.12 (0.08 to 0.16)	<0.001
	Preop to 6 mo	0.12 (0.07 to 0.17)	<0.001
	3 mo to 6 mo	0.00 (−0.03 to 0.03)	0.974
CDVA	Preop to 3 mo	0.10 (0.06 to 0.13)	<0.001
	Preop to 6 mo	0.10 (0.06 to 0.13)	<0.001
	3 mo to 6 mo	NA
CNVA	Preop to 3 mo	0.42 (0.31 to 0.54)	<0.001
	Preop to 6 mo	0.40 (0.28 to 0.51)	<0.001
	3 mo to 6 mo	−0.02 (−0.07 to 0.02)	0.271
CIVA	3 mo to 6 mo	0.04 (−0.02 to 0.11)	0.148
Symfony (PPV)
UDVA	Preop to 3 mo	0.46 (0.07 to 0.84)	0.024
	Preop to 6 mo	0.54 (0.15 to 0.93)	0.011
	3 mo to 6 mo	0.08 (0.05 to 0.11)	<0.001
CDVA	Preop to 3 mo	0.05 (0.01 to 0.09)	0.019
	Preop to 6 mo	0.13 (0.08 to 0.17)	<0.001
	3 mo to 6 mo	0.07 (0.05 to 0.10)	<0.001
CNVA	Preop to 3 mo	0.20 (0.05 to 0.36)	0.015
	Preop to 6 mo	0.34 (0.20 to 0.48)	<0.001
	3 mo to 6 mo	0.14 (0.08 to 0.20)	<0.001
CIVA	3 mo to 6 mo	0.09 (0.05 to 0.12)	<0.001
Precizon^c)
UDVA	Preop to 3 mo	0.10 (−0.03 to 0.23)	0.091
	Preop to 6 mo	0.08 (−0.09 to 0.24)	0.251
	3 mo to 6 mo	−0.02 (−0.08 to 0.04)	0.374
ΔCDVA	Preop to 3 mo	0.14 (0.07 to 0.21)	0.005
	Preop to 6 mo	0.16 (0.05 to 0.27)	0.017
	3 mo to 6 mo	0.02 (−0.03 to 0.07)	0.374
ΔCNVA	Preop to 3 mo	0.24 (−0.06 to 0.54)	0.086
	Preop to 6 mo	0.24 (−0.06 to 0.54)	0.086
	3 mo to 6 mo	0.00 (−0.09 to 0.09)	>0.999
ΔCIVA	3 mo to 6 mo	0.00 (−0.09 to 0.09)	0.984
Precizon (PPV)
UDVA	Preop to 3 mo	0.08 (−0.10 to 0.27)	0.294
	Preop to 6 mo	0.14 (−0.10 to 0.38)	0.181
	3 mo to 6 mo	0.06 (−0.01 to 0.13)	0.071
CDVA	Preop to 3 mo	0.05 (−0.03 to 0.12)	0.180
	Preop to 6 mo	0.12 (0.01 to 0.23)	0.037
	3 mo to 6 mo	0.08 (0.02 to 0.13)	0.016
CNVA	Preop to 3 mo	0.07 (−0.28 to 0.41)	0.621
	Preop to 6 mo	0.48 (0.26 to 0.70)	0.004
	3 mo to 6 mo	0.41 (0.10 to 0.72)	0.021
CIVA	3 mo to 6 mo	0.20 (0.11 to 0.29)	0.003

Δ, change between time points; CI, confidence interval; UDVA, uncorrected distance visual acuity; CDVA, corrected distance visual acuity; CNVA, corrected near visual acuity; CIVA, corrected intermediate visual acuity; PPV, pars plana vitrectomy; Preop, preoperative; NA, not applicable (standard error of the difference is zero due to identical values).

^a)Advanced monofocal intraocular lens (IOL) group;

^b)Hybrid diffractive extended-depth-of-focus (EDoF) IOL group;

^c)Hybrid refractive EDoF IOL.

Table 4.

Comparison of visual outcomes and foveal thickness at 6 months post-surgery among pars plana vitrectomy with epiretinal membrane peeling groups using the Kruskal-Wallis test

Outcome	χ²	P-value
Uncorrected distance visual acuity	3.395	0.183
Corrected distance visual acuity	0.244	0.885
Corrected intermediate visual acuity	1.105	0.575
Corrected near visual acuity	2.356	0.308
Foveal thickness	2.879	0.237

References

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Clinical outcomes of combined phacoemulsification and epiretinal membrane peeling using three advanced intraocular lens platforms

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Clinical outcomes of combined phacoemulsification and epiretinal membrane peeling using three advanced intraocular lens platforms

Fig. 1. Defocus curves of the three intraocular lens types at 6 months postoperatively. (A) Eyes that underwent pars plana vitrectomy with epiretinal membrane (ERM) peeling. (B) Control eyes. D, diopter; logMAR, logarithm of the minimum angle of resolution. a)Advanced monofocal intraocular lens (IOL) group; b)Hybrid diffractive extended-depth-of-focus (EDoF) IOL group; c)Hybrid refractive EDoF IOL.

Fig. 1.

Clinical outcomes of combined phacoemulsification and epiretinal membrane peeling using three advanced intraocular lens platforms

Demographic	Eyhance^a)			Symfony^b)			Precizon^c)
Demographic	No PPV (n=15)	PPV (n=15)	P-value	No PPV (n=15)	PPV (n=15)	P-value	No PPV (n=5)	PPV (n=5)	P-value
Age (yr)	68.07±6.18	67.93±11.17	0.847	62.00±6.92	60.40±5.60	0.487	65.00±9.27	67.00±5.10	0.684
Sex, male/female	8/7	7/8	0.726	5/10	4/11	0.787	1/4	2/3	0.545
SE (D)	−0.40±1.81	−0.18±2.28	0.694	−1.52±4.42	−1.37±4.20	0.781	−0.85±1.38	0.75±0.85	0.014
Foveal thickness (µm)	263.00±18.45	360.50±80.82	<0.001	256.31±23.41	333.73±61.49	<0.001	273.40±17.42	396.00±36.55	0.009
UDVA (logMAR)	0.19±0.18	0.64±0.42	0.001	0.16±0.08	0.58±0.71	<0.001	0.18±0.09	0.28±0.08	0.100
CDVA (logMAR)	0.09±0.11	0.37±0.35	0.001	0.12±0.06	0.16±0.05	0.015	0.18±0.09	0.16±0.06	0.911
CNVA (logMAR)	0.62±0.23	0.62±0.25	0.733	0.60±0.21	0.61±0.18	0.678	0.52±0.18	0.76±0.15	0.054

Variable	Eyhance^a)			Symfony^b)			Precizon^c)
Variable	No PPV (n=15)	PPV (n=15)	P-value	No PPV (n=15)	PPV (n=15)	P-value	No PPV (n=5)	PPV (n=5)	P-value
Postoperative 3 mo
SE (D)	−0.07±0.54	−0.13±0.52	0.824	−0.39±0.46	−0.40±0.66	0.614	−1.15±0.82	−0.80±0.87	0.343
Foveal thickness (µm)	268.27±19.52	354.29±70.82	<0.001	258.38±23.29	325.87±56.49	<0.001	270.40±13.47	379.80±29.74	0.009
UDVA (logMAR)	0.03±0.04	0.13±0.11	0.004	0.04±0.05	0.13±0.07	0.002	0.08±0.08	0.20±0.07	0.049
CDVA (logMAR)	0.01±0.03	0.02±0.04	0.258	0.02±0.04	0.11±0.06	<0.001	0.04±0.05	0.12±0.05	0.042
CIVA (logMAR)	0.14±0.09	0.18±0.08	0.186	0.12±0.09	0.22±0.09	0.009	0.16±0.06	0.36±0.05	0.007
CNVA (logMAR)	0.33±0.12	0.33±0.11	0.891	0.17±0.08	0.41±0.15	<0.001	0.28±0.15	0.69±0.18	0.013
Postoperative 6 mo
SE (D)	−0.10±0.43	−0.14±0.48	0.532	−0.38±0.46	−0.38±0.57	0.791	−1.15±0.80	−0.65±0.68	0.292
Foveal thickness (µm)	262.87±17.80	339.07±73.90	<0.001	260.19±20.93	311.47±49.84	<0.001	271.80±16.22	347.00±27.15	0.009
UDVA (logMAR)	0.04±0.05	0.07±0.10	0.422	0.04±0.06	0.05±0.06	0.890	0.10±0.10	0.14±0.11	0.588
CDVA (logMAR)	0.01±0.03	0.03±0.05	0.058	0.02±0.04	0.04±0.05	0.200	0.02±0.04	0.04±0.09	0.881
CIVA (logMAR)	0.15±0.11	0.15±0.08	0.691	0.08±0.08	0.13±0.05	0.054	0.16±0.09	0.16±0.06	0.817
CNVA (logMAR)	0.33±0.11	0.32±0.09	0.872	0.20±0.08	0.27±0.10	0.040	0.28±0.13	0.28±0.08	0.914

Group	Time	Δ (95% CI)	P-value
Eyhance^a)
UDVA	Preop to 3 mo	0.15 (0.05 to 0.25)	0.005
	Preop to 6 mo	0.14 (0.04 to 0.24)	0.007
	3 mo to 6 mo	−0.01 (−0.03 to 0.01)	0.164
CDVA	Preop to 3 mo	0.08 (0.03 to 0.13)	0.003
	Preop to 6 mo	0.08 (0.03 to 0.13)	0.003
	3 mo to 6 mo	NA
CNVA	Preop to 3 mo	0.30 (0.15 to 0.46)	0.001
	Preop to 6 mo	0.30 (0.14 to 0.46)	0.001
	3 mo to 6 mo	0.00 (−0.02 to 0.02)	0.981
CIVA	3 mo to 6 mo	−0.01 (−0.03 to 0.02)	0.598
Eyhance (PPV)
UDVA	Preop to 3 mo	0.51 (0.27 to 0.76)	0.001
	Preop to 6 mo	0.57 (0.34 to 0.80)	<0.001
	3 mo to 6 mo	0.05 (0.00 to 0.11)	0.061
CDVA	Preop to 3 mo	0.35 (0.14 to 0.56)	0.003
	Preop to 6 mo	0.34 (0.14 to 0.53)	0.003
	3 mo to 6 mo	−0.01 (−0.03 to 0.01)	0.165
CNVA	Preop to 3 mo	0.29 (0.13 to 0.45)	0.002
	Preop to 6 mo	0.30 (0.14 to 0.46)	0.001
	3 mo to 6 mo	0.01 (−0.01 to 0.03)	0.165
CIVA	3 mo to 6 mo	0.03 (0.00 to 0.06)	0.040
Symfony^b)
UDVA	Preop to 3 mo	0.12 (0.08 to 0.16)	<0.001
	Preop to 6 mo	0.12 (0.07 to 0.17)	<0.001
	3 mo to 6 mo	0.00 (−0.03 to 0.03)	0.974
CDVA	Preop to 3 mo	0.10 (0.06 to 0.13)	<0.001
	Preop to 6 mo	0.10 (0.06 to 0.13)	<0.001
	3 mo to 6 mo	NA
CNVA	Preop to 3 mo	0.42 (0.31 to 0.54)	<0.001
	Preop to 6 mo	0.40 (0.28 to 0.51)	<0.001
	3 mo to 6 mo	−0.02 (−0.07 to 0.02)	0.271
CIVA	3 mo to 6 mo	0.04 (−0.02 to 0.11)	0.148
Symfony (PPV)
UDVA	Preop to 3 mo	0.46 (0.07 to 0.84)	0.024
	Preop to 6 mo	0.54 (0.15 to 0.93)	0.011
	3 mo to 6 mo	0.08 (0.05 to 0.11)	<0.001
CDVA	Preop to 3 mo	0.05 (0.01 to 0.09)	0.019
	Preop to 6 mo	0.13 (0.08 to 0.17)	<0.001
	3 mo to 6 mo	0.07 (0.05 to 0.10)	<0.001
CNVA	Preop to 3 mo	0.20 (0.05 to 0.36)	0.015
	Preop to 6 mo	0.34 (0.20 to 0.48)	<0.001
	3 mo to 6 mo	0.14 (0.08 to 0.20)	<0.001
CIVA	3 mo to 6 mo	0.09 (0.05 to 0.12)	<0.001
Precizon^c)
UDVA	Preop to 3 mo	0.10 (−0.03 to 0.23)	0.091
	Preop to 6 mo	0.08 (−0.09 to 0.24)	0.251
	3 mo to 6 mo	−0.02 (−0.08 to 0.04)	0.374
ΔCDVA	Preop to 3 mo	0.14 (0.07 to 0.21)	0.005
	Preop to 6 mo	0.16 (0.05 to 0.27)	0.017
	3 mo to 6 mo	0.02 (−0.03 to 0.07)	0.374
ΔCNVA	Preop to 3 mo	0.24 (−0.06 to 0.54)	0.086
	Preop to 6 mo	0.24 (−0.06 to 0.54)	0.086
	3 mo to 6 mo	0.00 (−0.09 to 0.09)	>0.999
ΔCIVA	3 mo to 6 mo	0.00 (−0.09 to 0.09)	0.984
Precizon (PPV)
UDVA	Preop to 3 mo	0.08 (−0.10 to 0.27)	0.294
	Preop to 6 mo	0.14 (−0.10 to 0.38)	0.181
	3 mo to 6 mo	0.06 (−0.01 to 0.13)	0.071
CDVA	Preop to 3 mo	0.05 (−0.03 to 0.12)	0.180
	Preop to 6 mo	0.12 (0.01 to 0.23)	0.037
	3 mo to 6 mo	0.08 (0.02 to 0.13)	0.016
CNVA	Preop to 3 mo	0.07 (−0.28 to 0.41)	0.621
	Preop to 6 mo	0.48 (0.26 to 0.70)	0.004
	3 mo to 6 mo	0.41 (0.10 to 0.72)	0.021
CIVA	3 mo to 6 mo	0.20 (0.11 to 0.29)	0.003

Outcome	χ²	P-value
Uncorrected distance visual acuity	3.395	0.183
Corrected distance visual acuity	0.244	0.885
Corrected intermediate visual acuity	1.105	0.575
Corrected near visual acuity	2.356	0.308
Foveal thickness	2.879	0.237

Table 1. Demographics and preoperative clinical characteristics of the study patients at baseline

Values are presented as mean±standard deviation. Visual acuity is expressed as logarithm of the minimum angle of resolution (logMAR).

PPV, pars plana vitrectomy; SE, spherical equivalent; D, diopter; UDVA, uncorrected distance visual acuity; CDVA, corrected distance visual acuity; CNVA, corrected near visual acuity.

Advanced monofocal intraocular lens (IOL) group;

Hybrid diffractive extended-depth-of-focus (EDoF) IOL group;

Hybrid refractive EDoF IOL.

Table 2. Postoperative visual acuity, refraction, and foveal thickness compared with controls

Values are presented as mean±standard deviation. Visual acuity is expressed as logarithm of the minimum angle of resolution (logMAR).

Advanced monofocal intraocular lens (IOL) group;

Hybrid diffractive extended-depth-of-focus (EDoF) IOL group;

Hybrid refractive EDoF IOL.

Table 3. Temporal changes in visual acuity within each intraocular lens group

Advanced monofocal intraocular lens (IOL) group;

Hybrid diffractive extended-depth-of-focus (EDoF) IOL group;

Hybrid refractive EDoF IOL.

Table 4. Comparison of visual outcomes and foveal thickness at 6 months post-surgery among pars plana vitrectomy with epiretinal membrane peeling groups using the Kruskal-Wallis test