Mencucci Rita, Romualdi Giovanni, De Vitto Chiara, Cennamo Michela
Eye Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
Life (Basel). 2024 Feb 9;14(2):243. doi: 10.3390/life14020243.
Descemet membrane endothelial keratoplasty (DMEK) is currently regarded as the most effective surgical procedure for addressing Fuchs Endothelial Corneal Dystrophy (FECD), frequently performed in conjunction with cataract surgery. In this retrospective study, we present a comparison of visual performance, clinical outcomes, and optical quality between two types of monofocal Intraocular Lenses (IOLs): one standard and one enhanced intermediate vision model, implanted in patients who underwent combined phacoemulsification and DMEK surgery.
This single center comparative retrospective study was conducted at the Eye Clinic of the University of Florence (Italy) and included a total of 48 eyes of 48 patients affected by FECD and cataract. All patients underwent combined DMEK with phacoemulsification procedures. The patients' data were analyzed and divided into two groups: one group (standard group) consisted of 24 eyes that underwent phaco-DMEK with implantation of a monofocal IOL, and the second group (enhanced monofocal group) included 24 eyes that underwent phaco-DMEK with implantation of an enhanced monofocal IOL. In both groups, the following monocular visual outcomes were evaluated 6 months after surgery: Uncorrected Distance Visual Acuity (UDVA) and Best-Corrected Distance Visual Acuity (BCDVA) at 4 mts; Uncorrected Intermediate Visual Acuity (UIVA), Distance-Corrected Intermediate Visual Acuity (DCIVA) at 66 cm; Uncorrected Near Visual Acuity (UNVA) and Best Corrected Near Visual Acuity (BCNVA). Monocular defocus curves were also assessed. Furthermore, optical quality in terms of Contrast Sensitivity (CS) in photopic conditions, Higher-Order Aberrations (HOAs) at a pupil size of 5 mm. Modulation Transfer Function (MTF), Objective Scatter Index (OSI), and Strehl ratio, were also analyzed. A Patient-Reported Spectacle Independence Questionnaire was revised to evaluate spectacle independence outcomes.
the two groups did not exhibit statistically significant differences in terms of UDVA, BCDVA, UNVA and BCNVA, photopic CS, HOAs, OSI, Strehl ratio, and MTF. However, in the phaco-DMEK enhanced monofocal IOL group, significantly better results were observed in terms of UIVA and DCIVA as well as a different defocus curve profile at 1.50 D, providing better defocus results at intermediate distance compared with the ZCB00 IOL.
In our study, we found that enhanced monofocal lens performed favorable visual outcomes, even in cases of FECD, compared to standard monofocal IOLs. Comparable optical quality observed in the Eyhance group could allow surgeons to consider these lenses as a viable option for selected patients with FECD.
Descemet膜内皮角膜移植术（DMEK）目前被认为是治疗Fuchs内皮角膜营养不良（FECD）最有效的手术方法，常与白内障手术联合进行。在这项回顾性研究中，我们比较了两种单焦点人工晶状体（IOL）植入接受白内障超声乳化联合DMEK手术患者后的视力表现、临床结果和光学质量，这两种IOL一种是标准型，另一种是增强型中视力模型。
这项单中心比较回顾性研究在意大利佛罗伦萨大学眼科诊所进行，共纳入48例患有FECD和白内障的患者的48只眼。所有患者均接受了DMEK联合白内障超声乳化手术。对患者数据进行分析并分为两组：一组（标准组）包括24只接受白内障超声乳化联合DMEK手术并植入单焦点IOL的眼，另一组（增强型单焦点组）包括24只接受白内障超声乳化联合DMEK手术并植入增强型单焦点IOL的眼。两组均在术后6个月评估以下单眼视力结果：4米处的未矫正远视力（UDVA）和最佳矫正远视力（BCDVA）；66厘米处的未矫正中视力（UIVA）、距离矫正中视力（DCIVA）；未矫正近视力（UNVA）和最佳矫正近视力（BCNVA）。还评估了单眼散焦曲线。此外，还分析了明视条件下的对比敏感度（CS）、瞳孔直径为5毫米时的高阶像差（HOA）、调制传递函数（MTF）、客观散射指数（OSI）和斯特列尔比率等光学质量指标。修订了患者报告的眼镜依赖问卷以评估眼镜依赖结果。
两组在UDVA、BCDVA、UNVA和BCNVA、明视CS、HOA、OSI、斯特列尔比率和MTF方面均无统计学显著差异。然而，在白内障超声乳化联合DMEK增强型单焦点IOL组中，UIVA和DCIVA以及1.50 D时不同的散焦曲线轮廓方面观察到显著更好的结果，与ZCB（此处可能有误，推测应为ZCB00）IOL相比，在中间距离提供了更好的散焦结果。
在我们的研究中，我们发现与标准单焦点IOL相比，增强型单焦点晶状体即使在FECD病例中也能取得良好的视力结果。在Eyhance组中观察到的可比光学质量可能使外科医生将这些晶状体视为选定的FECD患者的可行选择。
