Proactive Iol Exchange

To describe the bennefits of proactively exchanging a clear hydrophilic IOL in the setting of endothelial keratoplasty surgery.

Private practice

A 66 year-old patient presented complaining of decreased vision in her left eye. She has Fuchs endothelial corneal dystrophy and had been submitted to cataract surgery elsewhere 3 years before, with the implantation of a multifocal IOL. There was an obvious central corneal edema with a hydrophilic plate-haptic IOL inserted inside the capsular bag. There was also significant PCO compromising her vision even further.

DMEK was chosen to restore her corneal transparency however, the hydrophilic multifocal IOL was a bit of a concern. Calcification of these lenses after sequential surgery has been reported across all platforms; including this specific model. Nevertheless, this IOL was pristine with no signs of opacification at all. 

A more interventional approach by proactively exchanging this clear lens was taken. After removing the hydrophilic lens, a monofocal, hydrophobic IOL was chosen and implated inside the bag. DMEK was finally performed at the end to restore her cornea.

Surgery undewent uneventfully and her uncorrected vision was restored to 20/20 up to 5 years after surgery. 

It is known that hydrophilic IOLs should be avoided in patients that may require EK in the future. However, when facing an eye with such a lens and the need of a DMEK, there is always a concern. Dealing with an opacified IOL after a corneal graft is not a comfortable situation and the risk of graft failing when exchanging the lens just adds to the complexity. Even being a somehow rare complication, a proactive IOL exchange might be beneficial for these patients and this case shows it can be safely performed.