Outcomes of phacoemulsification after Descemet membrane endothelial keratoplasty.

Abstract

PURPOSE:

To evaluate the feasibility and outcomes of phacoemulsification after Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy and bullous keratopathy.

SETTING:

Tertiary referral center.

DESIGN:

Comparative case series.

METHODS:

The case notes of all phakic DMEK patients who subsequently had cataract surgery were reviewed, and data from a prospectively recorded database were analyzed. This included demographic details, visual acuity, corneal pachymetry, endothelial cell density (ECD), refractive outcomes, and complications.

RESULTS:

From a series of 106 consecutive phakic DMEK eyes, 5 eyes (4.7%) required phacoemulsification a mean of 9.2 months ± 3.7 (SD) (range 4 to 14 months) after the initial DMEK. All phacoemulsification procedures were uneventful, and no dislocations and/or detachments of the Descemet graft were observed. At 6 to 12 months, all eyes reached a corrected distance visual acuity of 20/30 (0.6) or better and were within ±0.50 diopter of the target refraction. Endothelial cell density decreased from a mean of 1535 ± 195 cells/mm(2) before phacoemulsification to 1158 ± 250 cells/mm(2) 6 to 12 months after phacoemulsification. No significant changes in pachymetry values were observed, and all corneas remained clear throughout the study.

CONCLUSIONS:

Phacoemulsification after DMEK can be performed with minimal risk for graft detachment. The postoperative refractive outcomes were predictable, and visual acuity is likely to improve; there was an acceptable decrease in ECD.

FINANCIAL DISCLOSURE:

Dr. Melles is a consultant to D.O.R.C. International BV/Dutch Ophthalmic USA. No author has a financial or proprietary interest in any material or method mentioned.

• Authors: Fayyaz U Musa, Javier Cabrerizo, Ruth Quilendrino, Isabel Dapena, Lisanne Ham, Gerrit R J Melles
• Journal: Journal of cataract and refractive surgery (J Cataract Refract Surg) Vol. 39 Issue 6 Pg. 836-40 (Jun 2013) ISSN: 1873-4502 [Electronic] United States
• PMID: 23571287 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Cell Count
• Corneal Diseases (surgery)
• Corneal Endothelial Cell Loss (diagnosis)
• Corneal Pachymetry
• Descemet Stripping Endothelial Keratoplasty
• Feasibility Studies
• Female
• Humans
• Lens Implantation, Intraocular
• Male
• Middle Aged
• Phacoemulsification
• Postoperative Care
• Prospective Studies
• Pseudophakia (physiopathology)
• Refraction, Ocular (physiology)
• Treatment Outcome
• Visual Acuity (physiology)