Descemet Membrane Endothelial Keratoplasty After Multifocal IOL Implantation

Friday, April 17, 2015
KIOSKS (San Diego Convention Center)
Nicolas C. Pereira, MD
Adriana S. Forseto, MD
Ruy N. Cunha Filho, MD
Tatiana Prazeres, MD
Ramon C. Ghanem, MD, PhD
Walton Nosé, MD, PhD

Purpose
To describe the results of Descemet Membrane Endothelial Keratoplasty (DMEK) performed in patients with endothelial dysfunction after multifocal intraocular lens implantation (IOL).

Methods
Retrospective review of 7 patients (n= 7 eyes) that developed bullous keratopathy after cataract surgery with multifocal IOL implantation, and were managed with DMEK. Causes of endothelial failure were: Descemet membrane detachment (n=1), toxic anterior segment syndrome (n=1), traumatic surgery with posterior capsule rupture, vitreous loss and IOL scleral fixation (n=1), Fuchs Endothelial Distrophy (n=2) and unnknown (n=2). Clinical results were described.

Results
Early postoperative partial graft detachment occurred in 2 eyes, requiring one re-bubble each. No other complication was noted. At one month after surgery no cornea edema was observed. and 6 patients had best-corrected distance visual  acuity (BCDVA) of 20/30 or better. Two eyes required YAG laser capsulotomy for posterior capsule opacification.  and after that, all patients had BCDVA of 20/30 or better and best corrected near visual acuity of  J1 or better. Two patients underwent Excimer Laser ablation for residual refractive error, 3 and 7 months after DMEK. One month after laser surgery, those two patients had uncorrected visual acuity (UCVA) of 20/20 and 20/25 for far and J1 for near. At the last follow-up all patients had UCVA of 20/40 or better for far and J2 for near.

Conclusion
Bullous keratopathy in patients with multifocal IOL can be safely

managed with DMEK, yielding good visual outcomes and fast visual recovery.

Posterior capsule opacification and residual refractive errors may limit the

outcomes, but can be solved with Yag laser capsulotomy or Excimer Laser

refractive surgery respectively.