The Latest Triple Procedure: Descemet Membrane Endothelial Keratoplasty (dmek) Combined With Phacoemulsification And Intraocular Lens Implantation

Abstract

 

Purpose:

 

The purpose of this retrospective analysis was to evaluate the outcome after DMEK combined with phacoemulsification and intraocular lens implantation through a 2.5mm corneal incision.

 

Methods:

 

Triple - DMEK (DMEK with simultaneous cataract surgery) was performed in 50 consecutive eyes with Fuchs' endothelial dystrophy using Acritec IOL's and the same shooter for IOL implantation and graft injection.

 

Results:

 

BCVA was 0.61 ± 0.24 logMAR preoperatively (n = 42) and increased to 0.36 ± 0.20 logMAR at 1 month (n = 39) (p ≤ 0,005; paired t-test), to 0.24 ± 0.14 logMAR at 3 months (n = 27) (p ≤ 0,005; paired t-test) to 0.16 ± 0.08 logMAR at 6 months (n = 18) (p ≤ 0,005; paired t-test) and to 0.12 ± 0.05 logMAR at 12 months (n = 7) (p = n.s., paired t-test) after surgery. The mean mean spherical equivalent (SE) was -0.04 ± 2.6 D preoperatively (n = 49), 0.17 ± 1.1 D after 1 month (n = 43), 0.26 ± 1.7 D after 3 months (n = 30), 0.49 ± 1.3 D after 6 months (n = 19) and -0.31 ± 1.9 D after 12 months (n = 8) after surgery. No significant change in SE was noted in a follow up of 12 months (p = n.s., paired t-test). Within the first 6 months a trend towards a small hyperopic shift was noticed. 53.5% of the eyes reached a target refraction within ± 1 D after 1 month, 50.0% after 3 months; 42.1% after 6 months and 16.7% after 12 months. Topographic cylinder (TC) was 2.3 ± 1.9 D preoperatively (n = 48), 1.41 ± 1.1 D after 6 months (n = 18) and 1.7 ± 1.1 D after 12 months (n = 9) after surgery. Change in TC was statistically significant within 6 months (p ≤ 0.05; paired t-test) with no further statistically significant difference during the further up (p = n.s., paired t-test). The mean preoperative Endothelial cell density (ECD) of donor corneas was 2563 ± 272 cells/cm² (n = 49). After one month the ECD had decreased to 1491 ± 220 cells/cm² (n = 38; (p < 0.005; t-test). The ECD at 6 months was 1536 ± 371 cells/cm² (n = 20; p = n.s.; paired t-test) and at 12 months 1365 ± 333 cells/cm² (n = 8; p = n.s.; paired t-test).t-test).

 

Conclusions:

 

Use of an IOL shooter for injection of both the IOL and the graft allows performing the triple procedure with low postoperative astigmatism, fast visual recovery, good predictability of SE and excellent postoperative function.

 

Keywords: cornea: clinical science • cornea: endothelium