Authors: Markéta Brožková 1,2; Ondřej Vlasák 1; Lenka Havlíčková 1; Zuzana Hlinomazová 1 Authors‘ workplace: Lexum Eye Clinics, Czech Republic 1; Faculty of Medicine in Hradec Králové, Charles University, Czech Republic 2 Published in: Čes. a slov. Oftal., 82, 2026, No. Ahead of Print, p. 1-7 Category: Original Article doi: https://doi.org/10.31348/2026/4
Purpose: The aim of this retrospective study was to evaluate the outcomes of refractive lens exchange (RLE) with implantation of extended depth of focus (EDOF) and trifocal intraocular lenses (IOLs) in presbyopic hyperopic patients diagnosed with Fuchs endothelial corneal dystrophy (FECD), and to retrospectively assess preoperative criteria suitable for RLE indication.
Materials and Methods: The study included 17 patients (34 eyes) with hyperopia and FECD who underwent RLE with implantation of EDOF or trifocal IOLs at Lexum Eye Clinics between 2022 and 2024. The mean follow-up period was 13 months, and the mean patient age was 56 ±5 years. Evaluated parameters included preoperative and postoperative refraction, visual acuity, endothelial microscopy, central pachymetry, and posterior corneal backscatter.
Results: The mean preoperative uncorrected distance visual acuity was 0.68 logMAR, improving postoperatively to 0.01 logMAR. The mean corrected distance visual acuity improved from 0.01 logMAR preoperatively to -0.01 logMAR postoperatively. Postoperative uncorrected intermediate and near visual acuities were 0.07 logMAR and 0.10 logMAR, respectively. According to Krachmer’s classification of endothelial microscopy, 14 patients had grade 1, one patient grade 2, and two patients grade 3 FECD. The mean postoperative endothelial cell density was 2595 cells/mm², with a coefficient of variation of 30 % and hexagonality of 50 %. No statistically significant difference was found between preoperative and postoperative pachymetry values (p = 0.184). The mean posterior corneal backscatter was 14.7 GSU preoperatively and 16.8 GSU postoperatively.
Conclusion: Fuchs endothelial corneal dystrophy has long been considered a contraindication for refractive lens exchange. In our cohort of motivated patients, the outcomes were highly satisfactory. Key parameters – central pachymetry, endothelial microscopy, and posterior corneal backscatter remained stable over time. When properly indicated, carefully performed RLE may be a viable option for presbyopia correction in patients with early-stage FECD.
Fuchs endothelial corneal dystrophy – RLE – trifocal IOL – EDOF IOL – endothelial microscopy
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