Fibrin Membrane Formation Following Enova Advanced Edof Intraocular Lens Implantation: Conservative Management With Intensive Topical Corticosteroid Therapy

To report a rare case of early fibrin membrane formation following uncomplicated phacoemulsification with Enova Advanced extended depth of focus (EDOF) intraocular lens (IOL) implantation and to describe successful conservative management with intensive topical corticosteroid therapy, emphasizing the importance of early recognition and appropriate treatment to preserve the excellent visual outcomes expected with premium EDOF technology.

Tertiary ophthalmology department, university teaching hospital, specializing in premium cataract surgery and advanced IOL implantation techniques.

A 58-year-old female patient underwent bilateral sequential phacoemulsification with Enova Advanced EDOF IOL (VSY Biotechnology) implantation using standard microincisional cataract surgery technique. The Enova Advanced features non-diffractive Light Tailoring Technology on a 100% glistening-free hydrophobic acrylic platform. Comprehensive preoperative evaluation, detailed surgical documentation, sequential photographic documentation of fibrin membrane development and resolution, visual acuity measurements, anterior segment optical coherence tomography (AS-OCT), and systematic follow-up examinations over 6 months were performed. Conservative management protocol included intensive prednisolone acetate 1% with gradual tapering and cycloplegic therapy.On postoperative day 3, the patient presented with decreased vision (BCVA 0.2) and mild discomfort. Examination: 2+ anterior chamber cells, trace flare, and a dense fibrin membrane partially covering the pupillary area and IOL optic. Intensive topical prednisolone acetate 1% hourly and cyclopentolate 1% three times daily were started. Within 72 hours, the fibrin membrane regressed significantly with BCVA improving to 0.5. Complete fibrin resolution was achieved by postoperative week 2, with BCVA reaching 1.0. At 6-month follow-up, distance BCVA was 1.0, intermediate vision 0.8 . EDOF performance remained fully preserved with high patient satisfaction. The fellow eye, 4 weeks later, had an uneventful postoperative course.

Early fibrin membrane formation can occur following premium EDOF IOL implantation despite uncomplicated surgery and does not appear to be specifically related to EDOF technology but rather represents individual inflammatory predisposition. Prompt recognition and aggressive topical corticosteroid therapy can achieve complete resolution without compromising the advanced optical performance of EDOF lenses. This case demonstrates that conservative management should be the first-line approach for early postoperative fibrin membranes, reserving interventional techniques for refractory cases.Surgeons should be alert to this rare complication after premium IOL implantation and treat it aggressively to maintain optimal visual outcomes.