Visual And Optical Quality Outcomes Of An Enhanced Monofocal Iol In Healthy Eyes And Mild Fuchs Endothelial Corneal Dystrophy

Published 2026 - 44th Congress of the ESCRS

Reference: POCAT420 | Type: Free paper | DOI: 10.82333/r8e4-vp70

Authors: Dr Alberto Carnicci* ¹ , Dr Matilde Buzzi ¹ , Dr Pier Giuseppe Ruggeri ¹ , Dr Luca Di Gregorio ¹ , Prof. Rita Mencucci ¹

¹Eye Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA),University of Florence,Florence,Italy

Purpose

To compare 6-month visual, optical quality, endothelial safety, and patient-reported outcomes after bilateral implantation of the enhanced monofocal Evolux IOL (SIFI spa, Catania, Italy) in healthy patients and in patients with mild Fuchs endothelial corneal dystrophy (FECD). The study aimed to determine whether early-stage FECD affects binocular visual performance, objective optical quality, contrast sensitivity, and disease-specific subjective visual function.

Setting

Retrospective comparative study conducted at Careggi Hospital, University of Florence (Italy). All surgeries were performed by the same experienced cataract surgeon using standard phacoemulsification techniques with bilateral implantation of the Evolux enhanced monofocal IOL.

Methods

Patients were divided into healthy controls and mild FECD (stage 1–2 according to Krachmer classification). Six months after bilateral implantation, binocular subjective outcomes included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), distance-corrected intermediate visual acuity (DCIVA), defocus curves, and contrast sensitivity. Objective optical quality (MTF cut-off, Strehl ratio, OSI) was assessed monocularly. Endothelial cell density (ECD) was recorded preoperatively and at 6 months. The Italian V-FUCHS questionnaire, assessing vision-related limitations and glare symptoms, was administered preoperatively and 6 months after second-eye surgery.

Results

Thirty patients (60 eyes) were included: 15 healthy and 15 mild FECD. At 6 months, binocular UDVA, CDVA, UIVA, DCIVA, and defocus curves were comparable between groups (all p>0.05). MTF cut-off, Strehl ratio, and OSI values were similar in healthy and FECD eyes (all p>0.05). Photopic contrast sensitivity was significantly lower in FECD patients (p<0.05). Mean cumulative dissipated energy (CDE) did not differ significantly between groups (p>0.05), with similar endothelial cell loss (7.8% vs 8.5%; p=0.56). The V-FUCHS visual acuity factor improved significantly in both groups (p<0.001) without intergroup differences (p=0.47), while the glare factor improved (p<0.05) but remained higher in FECD (p<0.05).

Conclusions

Enhanced monofocal Evolux implantation provides excellent binocular distance and intermediate vision with optical quality and endothelial safety comparable between healthy and mild FECD eyes. The disease-specific V-FUCHS questionnaire confirms significant improvement in visual acuity-related function after surgery in both groups, demonstrating meaningful functional benefit even in early-stage FECD. Although residual glare perception and contrast sensitivity remain slightly reduced in FECD patients, overall disease-specific visual function markedly improves, supporting enhanced monofocal Evolux IOL implantation as a safe and effective option in carefully selected early-stage FECD, allowing a cataract standalone approach.