Outcomes of Phacoemulsification After Descemet Membrane Endothelial Keratoplasty

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.