# Descemet membrane endothelial keratoplasty combined with secondary sulcus hydrophobic intraocular lens implantation

## TL;DR

A 74-year-old woman with Fuchs’ dystrophy had successful vision correction through a combined eye surgery involving DMEK and IOL implantation.

## Contribution

This case demonstrates a novel combined surgical approach for hyperopia correction in pseudophakic eyes with Fuchs’ dystrophy.

## Key findings

- Refraction improved from +5.25 D to +0.75 D with enhanced visual acuity over 10 months.
- Corneal clarity and endothelial cell density were restored post-surgery.
- No IOL opacification was observed, indicating the safety of the hydrophobic IOL.

## Abstract

To report a case of combined Descemet membrane endothelial keratoplasty (DMEK) and secondary sulcus hydrophobic intraocular lens (IOL) implantation for hyperopic correction in a pseudophakic eye with Fuchs’ endothelial corneal dystrophy.

A 74-year-old woman with Fuchs’ dystrophy and a history of phacoemulsification with a hydrophilic IOL in her left eye (refraction: +5.25 D/–1.00 D × 68°; best corrected visual acuity [BCVA]: 20/40) underwent a preparatory yttrium aluminum garnet (YAG) iridotomy followed by implantation of a hydrophobic add-on +8 D IOL in the ciliary sulcus through a 2.4 mm incision. DMEK was performed using a 90 % fill of 10 % sulfur hexafluoride (SF6). Two months after surgery, refraction improved to −0.25 D/–1.75 D × 62° (BCVA: 20/25), with restored corneal clarity and an endothelial cell density of 1920 cells/mm2. At 10 months, refraction was +0.75 D/–1.25 D × 54°, and BCVA further improved to 20/20, with an endothelial density of 1778 cells/mm2 and normalized corneal thickness. No IOL opacification was observed.

This case indicates that combining DMEK with secondary sulcus hydrophobic IOL implantation can effectively correct hyperopia in pseudophakic eyes with Fuchs’ dystrophy.