Prophylactic Iol Exchange With Dmek

To report the managment of a multifocal hydrophilic IOL in an eye with decompensated cornea.

Private practice

A 66-year-old patient with Fuchs Endothelial Dystrophy presented with decompensated corneal edema in the left eye after having performed cataract surgery with implantation of a hydrophilic multifocal IOL elsewhere. She was complaining of severely decreased visual acuity and foreign body sensation. Her multifocal plate-haptic IOL was well positioned within the capsular bag with a pristine clear optical zone. She had a dense posterior capsular opacification that was contributing to the poor vision. Since we were going to perform DMEK to treat the decompensated cornea, we decided to exchange the IOL to avoid any chance of opacification after gas injection during the endothelial keratoplasty. This way, if the posterior capsule had to be opened later on, it would not interfere with a possible IOL exchange at a second stage. Surgery underwent uneventful and the patient had a very satisfactory outcome.

Despite being a rare complication, calcification of hydrophylic lenses has been reported in many manufacturers and suppliers especially after intracameral gas injection. In patients with endothelial pathologies, the use of hydrophilic IOLs (and for that same reason, multifocal lenses) should be avoided as endothelial keratoplasty may be required in the future. And although IOL exchange can carry a considerable risk of complications, this case highlights that it can be safely combined with DMEK surgery.