Consider lens choice
IOL choice is another consideration in eyes undergoing an EK procedure. Dr. Ciralsky recommended avoiding hydrophilic materials and multifocal lenses, and giving cautious consideration to use of toric or accommodating IOLs.
“I prefer an aspheric monofocal IOL and do not use a multifocal IOL because they degrade contrast sensitivity and quality of vision,” she said. “Hydrophilic IOLs should not be used considering reports of opacification caused by air insertion during the EK procedure.”
The refractive target also needs to be modified in an eye having EK because the graft procedure causes a hyperopic shift. The magnitude of the shift is greater with DSAEK than with DMEK because the DSAEK graft is thicker. Dr. Ciralsky recommended aiming for -1 to -1.25 D of myopia when doing DSAEK and between -0.75 to -1 D in eyes undergoing DMEK.