Outcomes, Safety And Efficacy Of The Johnson And Johnson Tecnis Eyhance Icb00 Lens In Combined Phacoemulsification, Intraocular Lens Implantation And Descemet’S Membrane Endothelial Keratoplasty (Dmek)

The TECNIS EyhanceTM lens is a premium monofocal intraocular lens (IOL), purported to provide patients with enhanced unaided intermediate vision even when an emmetropic refractive aim is targeted. While we have observed a great deal of patient satisfaction with both distance and intermediate vision using this IOL in routine cataract surgery, there is a lack of evidence on outcomes of patients undergoing combined cataract surgery and DMEK. This study aims to determine the safety and efficacy of using an enhanced monofocal IOL (Eyhance) in DMEK triple procedures.

All surgeries were performed by a single surgeon (C Gunasekera) at a single centre (James Paget University Hospital). All patients had a diagnosis of visually significant cataract and Fuchs’ endothelial dystrophy. IOL lens choice was calculated using the Barrett Universal II formula and biometry obtained with the Zeiss IOLMaster 700. 

We obtained data of 15 eyes obtained from 10 patients (5 patients with individual eye surgeries, 5 patients with surgery performed to both eyes non-sequentially).

Qualitative data was obtained from the patients regarding their feelings on subjective change of distance vision post-operatively, as well as for change of symptoms such as glare or haloes around light sources (which can be associated with the defocusing associated with enhanced depth IOLs). We also enquired about patient’s subjective feelings regarding regarding unaided intermediate vision.

This was correlated with quantitive measurements of unaided distance vision and best corrected distance vision. Additionally we obtained measurements of intermediate vision and a post-operative refraction. 

40% of eyes achieved 6/6 best corrected Snellen vision or better and 100% achieved 6/9 or better.

8 of the 10 patients (12 eyes of the 15) responded to our requests about subjective feelings of intermediate vision, and symptoms of glare or haloes around lights. Of these patients, 100% reported an ability to read everyday type-print and/or use their mobile phone at 1 to 2 metres. This was borne out with favourable formal testing of intermediate vision.  

In 92% of these eyes, there were no such reported symptoms of glare or haloes after surgery. The remaining 8% of eyes only reported minimal symptoms that were much improved compared to their pre-operative state. 

Despite the pre-operative irregular cornea caused by underlying endothelial disease, we report good safety and efficacy of combined cataract and DMEK surgery with the Eyhance lens. There is a favourable side effect profile of symptoms of glare and haloes and functional intermediate vision in all patients. This study will be of interest to Ophthalmologists conducting triple DMEK procedures using enhanced monofocal IOLs.