Research Article Ophthalmic Res 2021;64:503–511 Clinical and Surgical Outcome of a Supplementary Multifocal Intraocular Lens Implanted with a Bag-In-the-Lens Intraocular Lens: 5-Year Follow-Up Thomas Verdonck a, b Liliana Werner c Sorcha Ní Dhubhghaill a, b Marie-José Tassignon a, b a Department of Ophthalmology, University Hospital of Antwerp (UZA), Edegem-Antwerp, Belgium; b Faculty of Medicine and Health Sciences, University of Antwerp (UAntwerpen), Antwerp, Belgium; c John A. Moran Eye Center, Salt Lake City, UT, USA Received: August 4, 2020 Accepted: November 20, 2020 Published online: December 16, 2020 Thomas Verdonck Department of Ophtalmology, University Hospital of Antwerp Wilrijkstraat 10 BE–2650 Edegem (Belgium) thomasverdonck @telenet.be © 2020 S. Karger AG, Basel karger@karger.com www.karger.com/ore DOI: 10.1159/000513790 Keywords Supplementary intraocular lens · implantation · Rayner sulcoflex · Dysphotopsia · Pigment deposits · Presbyopia correction Abstract Introduction: To assess the postoperative outcome and pa- tient-reported satisfaction, spectacle independence, and dysphotopsia after implantation with the mutifocal Rayner Sulcoflex supplementary intraocular lens (sIOL). Materials and Methods: We analyzed the outcome of all patients im- planted with a multifocal sIOL between 2009 and 2011. In all cases, the sIOL was the Rayner Sulcoflex IOL (type 653F) and the primary IOL was a bag-in-the-lens (BIL) IOL. The data were obtained through a retrospective analysis of the pa- tient records and by means of a questionnaire, 5 years after sIOL implantation. Results: This study included 31 eyes of 20 patients. In 13 eyes, the sIOL needed explantation (n = 13, 41.94%). Dysphotopsia is a frequent complaint (12/15 pa- tients: 80.0%) after sIOL implantation. In 13 out of 31 eyes (41.94%), pigment deposits were found on the sIOL with variable clinical complaints. Five eyes required additional surgery because of clinically significant deposits. Discus- sion/Conclusion: Patients with a multifocal sIOL in combina- tion with a BIL implantation have a higher incidence of dys- photopsia compared to previously published studies. Dys- photopsia was the main complaint and reason for explantation. We encountered a high incidence of pigment- ed IOL deposits. The sIOLs can be safely removed even years after implantation. © 2020 S. Karger AG, Basel Introduction Monofocal intraocular lenses (IOLs) provide an excel- lent means through which vision can be restored for a cho- sen target refraction following cataract or clear lens ex- traction. One significant limitation of the monofocal ap- proach is that they are usually accompanied by spectacle dependence for other focal points, unless monovision is applied. The “pseudophakic presbyopia,” induced by monofocal implants, is due to their inability to replicate the accommodation seen in the natural crystalline lens. Discovering the perfect lens implant, which would correct presbyopia and provide true spectacle independence, re- mains a major goal of research. Numerous surgical de-