Visual outcomes of aberration neutral versus monofocal plus IOLs in triple DMEK surgery

To compare visual acuity outcomes of two monofocal IOL models, a zero-aberration monofocal IOL (Envista MX60E; Bausch and Lomb) and a monofocal plus IOL (Eyhance DIB00; Johnson and Johnson), in eyes undergoing combined cataract surgery and Descemet membrane endothelial keratoplasty (DMEK) (triple DMEK).

Retrospective, single-center case series of 91 eyes (66 patients) undergoing triple DMEK with either IOL between 2019 and 2023 at a tertiary academic center. Eyes were divided into 2 groups: zero-aberration IOL (49 eyes) and monofocal plus IOL (42 eyes). Among these, 20 eyes received a zero-aberration IOL, and 26 eyes received a monofocal plus IOL in both eyes. Visual acuity measurements at 3-6 months and 6-12 months postoperatively included uncorrected distance, intermediate, and near (UDVA, UIVA, UNVA) and distance-corrected distance, intermediate, and near (CDVA, DCIVA, DCNVA) visual acuities for monocular (Uni) and binocular (Bi) assessments. Patients were administered the Intraocular Lens Satisfaction questionnaire to assess their level of spectacle independence at the 3-6 month visit. Statistical analysis was performed using Wilcoxon rank-sum and Fisher's exact tests.

UDVA_Uni, CDVA_Uni, and UNVA_Uni were favorable and comparable between the two groups. At the 3-6 month timepoint, the Eyhance group had significantly better UIVA_Uni (0.17 ± 0.12 vs. 0.23 ± 0.13, p = 0.03), DCIVA_Uni (0.23 ± 0.08 vs. 0.31 ± 0.08, p < 0.001), and DCNVA_Uni (0.36 ± 0.09 vs. 0.40 ± 0.08, p = 0.04). However, at 6-12 months, all six VA measurements were similar between the 2 groups. Bilateral cases at the 3-6 month timepoint demonstrated superior DCNVA_Bi in the Eyhance group versus the Envista group (0.31 ± 0.08 vs. 0.41 ± 0.03, p = 0.008). The spherical equivalent refractive error (- 0.51 ± 0.94D vs. - 0.55 ± 1.05D, p = 0.89) for all eyes and inter-eye refractive error in the binocular subgroup (0.29 ± 1.36D vs. 0.42 ± 1.11D, p = 0.80) was similar for both groups. Postoperative complications and patient satisfaction were comparable between the two groups.

Both IOLs can provide favorable corrected and uncorrected VA in triple DMEK eyes. Eyhance may provide better DCIVA_Uni and UIVA_Uni in single eyes and better DCNVA_Uni/Bi in all eyes up to six months postoperatively.