Abstract:AIM: To compare the visual outcomes between bilateral implantation of Tecnis ZXR00 extended depth-of-focus (EDOF) intraocular lenses (IOLs) and mixed implantation of Tecnis ZXR00 (EDOF) with Tecnis ZMB00 (bifocal) IOLs. METHODS: This postoperative cross-sectional study enrolled patients who underwent phacoemulsification combined with IOL implantation. Patients were divided into two groups: the bilateral ZXR00 group (ZXR00-only group) and the mixed IOL group (ZXR00+ZMB00 group). Primary outcome measures included uncorrected and corrected distance visual acuity (UDVA, CDVA), uncorrected and distance-corrected near visual acuity (UNVA, DCNVA), uncorrected and distance-corrected intermediate visual acuity (UIVA, DCIVA), and defocus curves. Secondary outcome measures were visual quality, spectacle independence, patient satisfaction, photic phenomena, and stereopsis. RESULTS: A total of 47 patients (94 eyes) were included, with 26 patients (11 males, 15 females) in the ZXR00-only group (mean age: 62.73±7.24y) and 21 patients (7 males, 14 females) in the mixed group (mean age: 65.71±9.16y). There was no statistically significant difference in age between the two groups (P=0.218). The mixed group showed significantly better binocular DCNVA compared to the ZXR00-only group (P=0.002). Defocus curve analysis revealed that the mixed group exhibited superior performance at −2.5 to −4.0 D but inferior performance at −0.5 and −1.5 D. Near stereoacuity was significantly poorer in the mixed group (Randot: 5.589±0.744 vs 6.240±0.394 ln arcsec; Contour: 4.966±0.973 vs 5.740±0.833 ln arcsec; both P<0.01). Both groups achieved high levels of spectacle independence and patient satisfaction, with no significant differences in photic phenomena or questionnaire scores. CONCLUSION: Mixed implantation of EDOF and bifocal IOLs improve near visual acuity but may compromise near stereopsis. This approach provides a viable option for patients prioritizing near vision; however, caution is recommended for individuals requiring fine stereoscopic vision for daily or professional tasks.
