Secondary sulcus IOL implantation for presbyopia correction following Descemet Membrane Endothelial Keratoplasty

Purpose: Report a case where the patient desired spectacle independence after phacoemulsification and Descemet membrane endothelial keratoplasty (DMEK) due to Fuchs' endothelial dystrophy.

Observations: A 52-year-old female presented with corrected distance visual acuity (CDVA) of 20/40 in both eyes with low ametropia. Slit lamp examination revealed corneal edema 1+/4+, guttae, and nuclear cataract 2+/4+ in both eyes. First, given the diagnostic suspicion of Fuchs' endothelial corneal dystrophy and cataracts, phacoemulsification with monofocal toric intraocular lens (IOL) implantation combined with DMEK was performed in both eyes. Postoperatively, the patient was not satisfied with her near vision. Therefore, a supplementary trifocal sulcus IOL was implanted into the right eye. At 30 days postoperatively, the uncorrected distance visual acuity (UDVA) was 20/20 and the uncorrected near visual acuity (UCNVA) was J1, with clear cornea, centered IOL.

Conclusions and importance: This is the first report of supplementary trifocal IOL implantation in a pseudophakic patient with a history of DMEK. This afforded spectacle-independence at all distances with high patient satisfaction. This procedure is safe, predictable, and reversible.