Descemet membrane endothelial keratoplasty in multifocal pseudophakic eyes

ABSTRACT Purpose: This report describes the use of Descemet membrane endothelial keratoplasty for the management of endothelial decompensation after multifocal intraocular lens implantation. Methods: In this retrospective study, we reviewed and assessed the surgical outcomes of 9 patients (9 eyes) who underwent Descemet membrane endothelial keratoplasty after multifocal intraocular lens implantation. Results: Corneal edema occurred due to Fuchs endothelial corneal dystrophy (n=3), pseudophakic bullous keratopathy (n=3), Descemet’s membrane detachment (n=2), and toxic anterior segment syndrome (n=1). The Descemet membrane endothelial keratoplasty surgeries were uneventful in all eyes, but rebubbling procedures were necessary in 2 eyes. One month after the surgery, all the corneas were clear. After 6 months, excluding 1 eye with amblyopia, the mean distance corrected visual acuity was 0.10 logMAR, with all eyes achieving 0.18 logMAR or better. Conclusions: This is the first report of Descemet membrane endothelial keratoplasty after multifocal intraocular lens implantation, and it suggests that good results can be achieved without multifocal intraocular lens exchange.

摘要
目的：本报告阐述了多焦点人工晶状体（multifocal intraocular lens）植入术后内皮失代偿的治疗中，角膜后弹力层内皮角膜移植术（Descemet membrane endothelial keratoplasty）的应用情况。
方法：本项回顾性研究纳入9例（共9眼）在多焦点人工晶状体植入术后接受角膜后弹力层内皮角膜移植术的患者，对其手术结局进行回顾与评估。
结果：患者角膜水肿的诱因为Fuchs内皮角膜营养不良（Fuchs endothelial corneal dystrophy，n=3）、假晶状体性大疱性角膜病变（pseudophakic bullous keratopathy，n=3）、后弹力层脱离（Descemet’s membrane detachment，n=2）以及毒性前节综合征（toxic anterior segment syndrome，n=1）。所有术眼的角膜后弹力层内皮角膜移植手术均顺利完成，但其中2眼需行气泡复位操作。术后1个月，所有术眼角膜均恢复透明。术后6个月，除1眼合并弱视外，患者平均远距离矫正视力为0.10对数最小分辨角（logMAR），所有术眼视力均达到0.18对数最小分辨角及以上。
结论：本报告为首例针对多焦点人工晶状体植入术后行角膜后弹力层内皮角膜移植术的相关报道，结果显示无需更换多焦点人工晶状体即可获得良好的手术效果。