This retrospective study analyzed patients who underwent bilateral PanOptix IOL implantation for cataract between July 2020 and September 2023 at Hangzhou MSK Eye Hospital, Hangzhou, China. The conduct of the study was in strict accordance with the principles of the Declaration of Helsinki and was approved by the Medical Ethics Committee of Hangzhou MSK Eye Hospital.

The inclusion criteria required patients to meet the following conditions: (1) presence of cataract with decreased vision; (2) have undergone femtosecond laser-assisted phacoemulsification cataract surgery with PanOptix IOL implantation; (3) preoperative corneal astigmatism of less than 1.00 D; (4) have a pupil diameter greater than 2.5 mm under photopic conditions and less than 6 mm under mesopic conditions; (5) exhibit total corneal HOA ≤ 0.5 μm (with undilated pupil, 4 mm diameter) before cataract surgery; (6) have corneal spherical aberration (SA) ranging from − 0.04 to 0.12 μm (with undilated pupil, 4 mm diameter); (7) potential acuity meter (PAM) score of ≥ 0.8.

The exclusion criteria included: (1) corneal decentered ablation with decentration exceeding 0.5 mm; (2) presence of corneal scar, retinoschisis, haze, myopic retinopathy, retinoschisis, or retinal detachment following myopia excimer laser correction; (3) other ocular or neurological conditions affecting trifocal IOL implantation, such as corneal disease, lens dislocation, uveitis, glaucoma, or retinopathy; (4) absence of follow-up data for 6 months.

Patients were categorized into two groups based on their history of prior myopic corneal refractive surgery using laser in situ keratomileusis (LASIK). Group A consisted of patients with a history of myopic LASIK prior to cataract surgery, whereas Group B included patients with no prior corneal refractive surgery, representing eyes without previous surgical intervention.

Patients underwent a thorough ophthalmologic assessment, which included the following evaluations: uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest and cycloplegic refractions, keratometry, slit-lamp microscopy, intraocular pressure (IOP) measurement, endothelial cell density (ECD) assessment (NSPC; KONAN, Japan), ultrasound A and B scans (Aviso, Quantel Medical, France), dilated indirect fundoscopy, Potential acuity meter (PAM-1; GASUSH, China), anterior segment tomography (Sirius; CSO, Florence, Italy), biometry (IOL Master 700; Carl Zeiss, Jena, Germany), and optical coherence tomography (OCT) (Cirrus HD-OCT 5000; Carl Zeiss, Jena, Germany).

A trifocal IOL (AcrySof IQ PanOptix, TNFT00, Alcon, Fort Worth, TX, USA) was implanted in all cases. The spherical aberration (SA) value for PanOptix intraocular lenses was − 0.1 μm. PanOptix IOL has been expected to provide acceptable visual acuity at distance, intermediate, and near by the design of splitting incoming light into 3 different focal points, with 50% for far vision, 25% for intermediate vision, and 25% distributed for near vision [16]. The IOL calculation was performed using Zhang & Zheng (ZZ) formula (published on BMC Ophthalmology 2021 [3]). ZZ IOL calculation for virgin eyes can be accessed at https://www.zzcal.com/calc/en/iol and for post-LASIK eyes can be accessed at https://www.zzcal.com/calc/en/iol_old. The IOL power was selected to target emmetropia.

Femtosecond laser-assisted phacoemulsification cataract surgery with PanOptix IOL implantation were performed by experienced surgeons. The surgical procedure was conducted as detailed in our previous article [3]. No complications were noted in any of the cases.

Follow-up evaluations were conducted at 1 week, 1 month, 3 months, and 6 months postoperatively. The study assessed the following outcome measures: (1) uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 60 centimeters, and uncorrected near visual acuity (UNVA) at 40 centimeters, at 1 week, 1 month, 3 months, and 6 months; (2) corrected distance visual acuity (CDVA), corrected intermediate visual acuity (CIVA) at 60 centimeters, and corrected near visual acuity (CNVA) at 40 centimeters, at 1 week, 1 month, 3 months, and 6 months; (3) manifest refraction spherical equivalent (MRSE) and refractive cylinder at 6 months; (4) the binocular defocus curve, which was collected in the same room and was performed from + 1.00 D to -4.00 D with 0.50 D step at 6 months; (5) contrast sensitivity, measured using a binoptometer (Binoptometer 4P; Oculus Optikgeräte GmbH), at 6 months; (6) patient satisfaction, evaluated using the VF-14 questionnaire, at 6 months; (7) A questionnaire assessing negative visual symptoms such as glare, halos, starburst, or ghosting at 6 months; (8) rate of spectacle independence at 6 month.

Statistical analysis was performed using SPSS software (version 22.0, SPSS, Inc., USA). The Kolmogorov-Smirnov test was applied to assess the normality of the data. Data with a normal distribution were reported as means ± standard deviations (SD). Visual acuity data were converted to logMAR values. Categorical variables were expressed as numbers and percentages. The independent-sample t test was used to compare data between Group A and Group B when the data followed a normal distribution; otherwise, the Mann-Whitney test was applied. Statistical significance was set at a P value of less than 0.05. Sample size calculation was performed using PASS 15.0 software (NCSS, LLC).