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Addon sulcus lens use after endothelial transplant in the prevention of in the bag lens opacification: 2 case reports

Poster Details

First Author: C. Azpitarte Sanchez-Muros SPAIN

Co Author(s):    B. Garcia Sandoval   N. Alejandre Alba                 

Abstract Details


Endothelial transplants can restore corneal homeostasis but intraocular lens opacification can be especially frequent after this surgery. The anterior chamber needs to be filled with air or gas and the contact with it can lead to the opacification of the intraocular lens (IOL) used in cataract surgery. The exchange of an opacified IOL can be very challenging in some cases. We report 2 cases of Descemet Membrane Endothelial Keratoplasty (DMEK) surgery where an Add-on hydrophilic neutral lens (0 diopters) was implanted in the sulcus to avoid opacification of a lens in the bag with high opacification risk.


Ophthalmology Department, Fundacion Jimenez Diaz Hospital, Madrid, Spain.


CASE REPORT 1 An 88-year-old woman with Fuchメs dystrophy underwent phacoemulsification in both eyes. Left eye underwent a DSAEK. 7 months after, the IOL revealed central opacification. Right eye underwent a DMEK. An Add-on sulcus-based A4SW00 neutral power IOL (Medicontur, Hungary) was implanted to prevent lens opacification in the second eye. 1 year later, none of the RE IOLs reveal opacification. CASE REPORT 2 A 76-year-old woman underwent phacoemulsification in right eye and a year later a DMEK. An Add-on sulcus-based A4SW00 neutral power IOL (Medicontur, Hungary) was implanted. 1 year later IOLs are preserved properly without sign of opacification.


OL opacification is more likely after procedures like triple DMEK. It can be extremely important in terms of vision, leading to the need of IOL explant. In pseudophakic patients that need an endothelial transplant in whom the surgeon believes there is a high risk of opacification, we propose the "off labelヤ use of neutral power add-on sulcus lens. It is an easy technique that does not interfere with DMEK surgery. Sulcus IOLs are easier to extract if opacification than in the bag IOLs. Moreover, it can be used to correct refractive errors at the same time in selected cases.


We propose a simple technique to prevent IOL opacification and its consequences in patients with high risk without interfering with DMEK surgery.

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