Refractive Outcomes With An Adapted Anterior Aspheric Monofocal Iol In Triple Descemet Membrane Endothelial Keratoplasty For Fuchs Endothelial Dystrophy

Fuchs endothelial dystrophy (FED) is a leading cause of corneal transplants, with cataract surgery in these patients posing challenges due to corneal abnormalities and refractive unpredictability. There are reports of hyperopic outcomes combined with refractive shifts seen post DMEK procedures. This creates challenges in intraocular lens (IOL) selection. Commonly, standard monofocal IOls are seen as the only option in  these patients, with inconclusive literature of multifocal and toric IOL outcomes. The Tecnis Eyhance, is a refractive IOL with a modified aspheric anterior surface creating a continuous power profile from periphery to centre. We evaluate refractive outcomes with this IOL in triple DMEK procedures in patients with FED.

This study was conducted across 2 large ophthalmic sites in the UK both performing  triple DMEK procedures (combined DMEK + phacoemulsification + IOL insertion).

A retrospective, interventional case series of 25 eyes that underwent a triple DMEK procedure for FED with an adapted anterior aspheric monofocal IOL was conducted. Surgical technique was consistent, firstly with phacoemulsification, in-the-bag Eyhance IOL insertion, followed by standardised DMEK.

Pre- and post-operative assessments included visual acuity, refractive error, corneal topography, and monocular defocus profiles.  Subjects were assessed 3-9 months post-op. Uncorrected and best corrected acuity were assessed both monocularly and binocularly at distance, intermediate (70cm) and near (40cm). Defocus from +1.50D to -4.00D was measured in 0.50D steps with additional points at +0.25D and -0.25D.  Pre and post-op corneal topography and aberrometry was obtained with the MS39 AS OCT. Statistical analysis was performed using SPSS software with a significant threshold of p<0.05. Independent t tests were used to assess differences in visual acuity. Repeated measures ANOVA was used to assess differences in defocus data.

The mean spherical equivalent (SE) aim, as predicated by the Barrett formulae was -0.54 ± 0.32, and actual post-operative spherical equivalent was 0.20 ± 0.97. Residual spherical equivalent was hyperopic in 60% of eyes.  A significant improvement was noted in corrected distance visual acuity (CDVA) from 0.37 ± 0.15 logMAR pre-operatively to 0.06 ± 0.08 logMAR post-operatively (p<0.01). The defocus profile showed significant visual acuity improvements between +1.00 and -1.50D of defocus. Corneal power reduced post-operatively in both meridians, yet there was an increase in corneal astigmatism. There were no significant changes in asphericity or spherical aberration.

The mean spherical equivalent (SE) aim, as predicated by the Barrett formulae was -0.54 ± 0.32, and actual post-operative spherical equivalent was 0.20 ± 0.97. Residual spherical equivalent was hyperopic in 60% of eyes.  A significant improvement was noted in corrected distance visual acuity (CDVA) from 0.37 ± 0.15 logMAR pre-operatively to 0.06 ± 0.08 logMAR post-operatively (p<0.01). The defocus profile showed significant visual acuity improvements between +1.00 and -1.50D of defocus. Corneal power reduced post-operatively in both meridians, yet there was an increase in corneal astigmatism. There were no significant changes in asphericity or spherical aberration.