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YAHIA Rekia, SOT Maxime, François Tortuyaux, Nadia ouamara, Jean-Marc Perone; DMEK AND CATARACT SURGERY : COMPARAISON OF SEQUENTIAL VERSUS COMBINED PROCEDURE. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5702.
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© ARVO (1962-2015); The Authors (2016-present)
The aim of this study is to describe the outcomes of phaco-DMEK (Descemet Membrane Endothelial Keratoplasty ) accordind to a sequential versus a combined procedure
Our descriptive and retrospective study included patients who underwent DMEK combined or not with cataract surgery between January 2014 and march 2016. Were excluded patients with other ocular comorbidity, and those who had graft after a first graft failure. The main outcome was BVCA measured at one year. The post-operative follow up was down at D7, M1, M3, M6, and M12. Secondary outcomes were; the mean time to visual recovery and influence of the delay between cataract removal and DMEK
31 eyes were included. 29 eyes had Fuchs dystrophy, 2 had pseudophakic bullous keratopathy . The first group includes 23 eyes underwent sequential procedure. Mean pre-operative BVCA was +0.71 logMAR (SD= 0.23), mean age was 71.3 years. Mean time between cataract surgery and DMEK was 15.8 months. The second group includes 8 eyes underwent combined procedure. Mean pre-operative BVCA was +0.72 logMAR (SD=0.25), mean age was 70.2 years. There was no difference between the two groups in terms of age and sex. Mean age of the graft donor was 75.3 years, and mean endothelial density was 2513 cells/mm2. In the first group mean BVCA at 1 year was +0.17 logMAR (SD=0.26). In the second group mean BVCA at 1 year was +0.19 logMAR (SD=0.24). There was no significant difference between the 2 groups. In the second group BVCA at D7 and M1 was better than in the first group. However both groups reach the same BVCA at 3 months. In the first group, patients who had graft surgery less than 6 months after cataract surgery had better visual outcomes ( +0.17 logMAR) than who underwent surgery more than 6 months ( +0.23 logMAR).
It doesn’t seem to exist a difference at one year between the two groups of patients. The combined procedure is associated to a faster amelioration of visual acuity in the first month. Our results remind the importance of an early graft procedure after phacoemulsification. However these results must be confirmed by a prospective randomized study.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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