Non-diffractive EDOF IOL Implantation After Combined DMEK and Cataract Surgery

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Purpose: To assess the efficacy of the AcrySof IQ Vivity non-diffractive extended depth of focus intraocular lens (EDOF IOL) (Alcon Laboratories, Inc) in patients with Fuchs' endothelial dystrophy undergoing Descemet membrane endothelial keratoplasty (DMEK), comparing visual outcomes between staged and simultaneous surgical approaches. Methods: This was a prospective, descriptive, single-center, non-randomized, comparative clinical study. Twenty-nine eyes from 29 patients with Fuchs' endothelial dystrophy were divided into the staged (n = 14) and simultaneous (n = 15) groups. Uncorrected and corrected distance, intermediate at 66 cm, and near at 40 cm visual acuity, refractive accuracy, corneal topography, and endothelial cell density were assessed preoperatively and at 12 weeks after cataract surgery. Patients also completed the Quality of Vision (QoV) questionnaire. Results: After 12 weeks, the staged group exhibited significantly better uncorrected and corrected visual acuity at distance, intermediate, and near ( P < .05). Refractive accuracy was similar between groups, with 72% of the staged and 60% of the simultaneous group within ±0.50 diopters of the target. The simultaneous group had higher endothelial cell density ( P < .001). QoV scores were comparable, indicating no significant differences in visual symptoms between groups. Conclusions: The AcrySof IQ Vivity EDOF IOL implantation during DMEK and cataract surgery yields favorable visual outcomes with minimal visual disturbances. Although the staged approach showed better visual acuity, both surgical strategies are viable options; patient-specific factors should guide the choice of surgical sequence.

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