Implantation of Presbyopia-Correcting Intraocular Lenses Staged After Descemet Membrane Endothelial Keratoplasty in Patients With Fuchs Dystrophy

Purpose: To assess outcomes of presbyopia-correcting intraocular lens (IOL) implantation after Descemet membrane endothelial keratoplasty (DMEK) in patients with Fuchs endothelial corneal dystrophy. Methods: This retrospective single-center study evaluated a consecutive series of patients with Fuchs endothelial corneal dystrophy who received presbyopia-correcting IOLs after DMEK. The main outcomes were corrected distance visual acuity, uncorrected distance visual acuity, uncorrected near visual acuity, and refractive error. Results: Fourteen extended depth of focus and 2 bifocal IOLs were implanted in 16 eyes of 8 patients (5 women and 3 men; age, 47-68 years). Fourteen IOLs were spherical and 2 were toric. Postoperatively, the median corrected distance visual acuity was 20/20 (range, 20/15-20/25), the median binocular uncorrected distance visual acuity was 20/25 (range, 20/15-20/25), the median binocular uncorrected near visual acuity was 20/20 (range, 20/20-20/50), and the median manifest spherical equivalent refraction was 0.05 diopters (D) (range, -0.75 to +0.75 D). Implantation of toric extended depth of focus lenses reduced refractive cylinder from 1 and 2.25 D preoperatively to 0 D in both eyes of 1 patient postoperatively. A comparison of biometry measurements taken before and after DMEK showed the median change in average keratometry was 0.26 D with a substantial range of -1.74 to +1.18 D. The median endothelial cell loss was 63 cells/mm(2)(3%) after staged phacoemulsification. Conclusions: Favorable visual and refractive outcomes were obtained with presbyopia-correcting IOLs in patients with Fuchs dystrophy when the biometry measurements and IOL implantation were staged after DMEK had cleared the guttae and corneal edema.