Postoperative Outcomes Of Descemet Membrane Endothelial Keratoplasty In A Patient With Pre-Existing Multifocal Intraocular Lenses

Descemet membrane endothelial keratoplasty (DMEK) is the gold-standard surgical intervention for Fuch's endothelial corneal dystrophy (FECD), offering superior visual outcomes and faster recovery compared to other techniques. There is growing interest in whether the higher-order aberration profile of DMEK recipients is compatible with multifocal intraocular lenses (MFIOLs) for patients seeking increased spectacle independence.

We present the visual outcomes of a 59-year-old male who underwent bilateral DMEK for FECD, with previously implanted MFIOLs.

This report highlights the postoperative outcomes of DMEK in patients with pre-existing MFIOLs, offering insights to optimize patient selection and improve outcomes in these rare cases.

West of England Eye Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom.

A 59-year-old male presented with worsening visual acuity of 0.20 logMAR in the right eye and 0.30 logMAR in the left eye. He had undergone bilateral lens replacement with MFIOL implantation in 2021. Slit-lamp examination revealed bilateral FECD with dense guttata but no corneal oedema. Given his symptoms, he opted for bilateral DMEK.

The patient underwent uncomplicated, postureless DMEK of the right eye in April 2024 and the left eye in February 2025. There were no intraoperative or postoperative complications.

At six months postoperatively, uncorrected visual acuity in the right eye was 0.10 logMAR, with a subjective refraction of +0.50/-1.00 × 140°. Three weeks after left-eye surgery, uncorrected visual acuity was 0.30 logMAR with a refraction of +2.50/-1.75 × 85°. Binocular uncorrected visual acuity was 0.10 logMAR for distance, N7 for intermediate, and N5.5 for near vision. Distance-corrected binocular visual acuities were 0.10 logMAR for distance, N5 for intermediate, and N4 for near vision.

A defocus curve of the right eye demonstrated vision better than 0.20 logMAR from +1.50 DS to -2.00 DS. Further improvement in the left eye is anticipated with continued postoperative recovery.

This case demonstrates successful visual rehabilitation in a patient with FECD who underwent bilateral DMEK following previous bilateral phacoemulsification with MFIOL implantation. Experience with such cases may increase confidence in selecting premium IOLs for phakic patients with a potential future need for DMEK.