{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:00:48Z","timestamp":1790834448217,"version":"4.1.0"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Selecting intraocular lenses (IOLs) for cataract patients with long axial length remains challenging. Two diffractive toric IOLs with distinct design combinations\u2014differing in material (hydrophobic vs. hydrophilic acrylic), optical design (trifocal vs. bifocal), haptic configuration (C-loop vs. plate-haptic), and IOL color (yellow-tinted vs. clear)\u2014represent commonly used options. This study compared their long-term visual outcomes and rotational stability. Notably, this study was not designed to isolate individual contributions of material or IOL color, as these factors covary; posterior capsule opacification (PCO) and Nd:YAG capsulotomy rates were not systematically evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective case series enrolled 57 patients (57 eyes) undergoing cataract surgery with toric multifocal IOL implantation (January\u2013December 2023), including 29 eyes receiving the hydrophobic trifocal IOL and 28 eyes receiving the hydrophilic bifocal IOL. Sample size was based on IOL rotation as the primary endpoint (\u226525 eyes per group to detect a 3\u00b0 difference, 80% power,\n                      <jats:italic>\u03b1<\/jats:italic>\n                      =0.05). Inclusion criteria required axial length \u226525.0\u2005mm and corneal astigmatism &amp;gt;0.75 D. Patients were followed at 1 week, 1 month, and 3 months postoperatively. Primary endpoint was IOL rotation at 3 months; secondary endpoints included uncorrected visual acuity, corneal astigmatism, defocus curve, objective visual quality, and satisfaction scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At 3 months, mean rotation was (2.83\u2009\u00b1\u20092.56)\u00b0 in the hydrophobic trifocal group and (3.25\u2009\u00b1\u20092.29)\u00b0 in the hydrophilic bifocal group (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05). At 1 month, uncorrected intermediate visual acuity (LogMAR) was significantly better in the hydrophobic trifocal group (0.01\u2009\u00b1\u20090.07 vs. 0.16\u2009\u00b1\u20090.09,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Cumulative uncorrected distance visual acuity of 0.1 LogMAR or better was achieved in 96.6% and 92.9% of eyes, respectively. No significant differences were found in uncorrected distance and near visual acuity, total higher-order aberrations, Strehl ratio, or questionnaire scores. Both IOLs achieved comparable visual quality and rotational stability despite design differences.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Both diffractive toric multifocal IOLs demonstrate comparable long-term visual outcomes and rotational stability in cataract patients with long axial length. Differences in material, haptic configuration, and IOL color did not result in significant visual quality disparities. The trifocal design demonstrates advantages in intermediate visual acuity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1856827","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:37:41Z","timestamp":1790833061000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term visual outcomes and rotational stability of two diffractive toric intraocular lenses with different design combinations in cataract patients with long axial length"],"prefix":"10.3389","volume":"13","author":[{"given":"Shuang","family":"Ni","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Shanghai Heping Eye Hospital, Shanghai University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongwei","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Shanghai Heping Eye Hospital, Shanghai University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Shanghai Heping Eye Hospital, Shanghai University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuanzhu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Shanghai Heping Eye Hospital, Shanghai University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Shanghai Heping Eye Hospital, Shanghai University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haike","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Shanghai Heping Eye Hospital, Shanghai University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1016\/j.jcrs.2012.08.060","article-title":"Prevalence of corneal astigmatism before cataract surgery in Chinese patients","volume":"39","author":"Chen","year":"2013","journal-title":"J Cataract Refract Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2020\/6385098","article-title":"Prevalence and age-related changes of corneal astigmatism in patients undergoing cataract surgery in northern China","volume":"2020","author":"Wu","year":"2020","journal-title":"J Ophthalmol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1038\/s41433-025-04207-0","article-title":"Posterior capsule opacification after cataract surgery in highly myopic patients: hydrophobic versus hydrophilic acrylic 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lenses","volume":"36","author":"Neumayer-Ammerer","year":"2010","journal-title":"J Cataract Refract Surg"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs-3856535\/v1","article-title":"Analysis of factors associated with rotational stability of toric intraocular lens after high axial myopia cataract surgery","author":"Lin","year":"2024","journal-title":"Res Sq"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1097\/j.jcrs.0000000000001013","article-title":"Standard for collecting and reporting outcomes of IOL-based refractive surgery: update for enhanced monofocal, EDOF, and multifocal IOLs","volume":"48","author":"Fern\u00e1ndez","year":"2022","journal-title":"J Cataract Refract Surg"},{"key":"B12","article-title":"Clinical evaluation of color perception after presbyopia-correcting IOL implantation: a comparative study of yellow-tinted and clear IOLs","year":"2025"},{"key":"B13","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1007\/s10384-019-00712-4","article-title":"Results of a clinical evaluation of a trifocal intraocular lens in Japan","volume":"64","author":"Bissen-Miyajima","year":"2020","journal-title":"Jpn J Ophthalmol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1856827\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:37:42Z","timestamp":1790833062000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1856827\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":13,"alternative-id":["10.3389\/fmed.2026.1856827"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1856827","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]},"article-number":"1856827"}}