Refractive Lens Exchange With An Extended Depth Of Focus Intraocular Lens In Fuchs Endothelial Dystrophy

Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.

The case involves a 66-year-old patient with high myopia and FED who experienced intolerance to contact lenses and sought spectacle independence for distance and intermediate vision. His corrected distance visual acuity was 20/30 in each eye and was unhappy with the deteriorating quality of vision. Examination revealed FED with no noticeable corneal oedema. In the right and left eye, his central corneal thickness was 506μ and 587μ, and the endothelial cell density (ECD) was 1225 cells/mm² and 1399 cells/mm².He had been for several consultations previously and was deemed ineligible for excimer and femtosecond laser–based refractive surgery due to age and FED. The patient's occupation as a commuter and builder emphasized the need for clear vision without visual disturbances such as glare and halos. The patient underwent a combined phacoemulsification with implantation of a toric EDOF IOL (Vivity, Alcon Laboratories, USA) and 7.75 mm diameter DMEK in both eyes 6 weeks apart. After 12 months, the uncorrected distance visual acuity was 20/16 in each eye, with 20/32 and 20/50 uncorrected near and intermediate visual acuity for 40 to 66 cm from the face in each eye, respectively. The ECD at 12 months was 2050 cells/mm² and 2100 cells/mm² in the right and left eyes, respectively. The patient was pleased with the outcomes.