Visual Recovery After Descemet Membrane Endothelial Keratoplasty in Eyes With Preexisting Multifocal Intraocular Lens

To assess visual acuity outcomes in pseudophakic eyes with a multifocal (MF)-IOL (intraocular lens) and endothelial failure receiving Descemet membrane endothelial keratoplasty (DMEK).

This is a retrospective case-series analyzing patients from the prospective Cologne DMEK database where visual acuity outcome in 14 eyes of 9 patients requiring DMEK after MF-IOL implantation was compared with 14 eyes of 14 age-matched controls for DMEK after monofocal IOL implantation. All patients suffered from Fuchs endothelial corneal dystrophy.

The average age at presentation was 69 ± 8.9 and 68 ± 7.6 years for cases and control group, respectively. Average pretransplant best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution was 0.45 ± 0.32 and 0.39 ± 0.19 among cases and control groups, respectively. After exclusion of 4 eyes with other visual acuity limitations and their age-matched control eyes, final average BCVA at follow-up among cases was 0.1 ± 0.07 at 3 months and 0.15 ± 0.10 at 6 months, whereas it was 0.14 ± 0.10 at 3 months ( P = 0.435) and 0.05 ± 0.05 at 6 months ( P = 0.054) of follow-up among the control group. When including eyes with IOL calcification, BCVA at 1 and 2 years in cases was significantly worse compared with controls. IOL calcification was more common in eyes with preexisting MF-IOL (3/14).

Good visual outcomes can be achieved in eyes where DMEK is done after MF-IOL implantation. Visual acuity recovery may be slower and slightly lesser compared with eyes with preexisting monofocal IOL in situ. The risk of IOL calcification seems higher in MF-IOLs.