Posters

One year complete bilateral visual rehabilitation in Fuchs' and cataract using phaco and DMEK in simultaneous and separate procedures

Poster Details

First Author: M.Naveiras SPAIN

Co Author(s):    C. Lisa   L. Fernandez-Vega Cueto   A. Meana   J. Alfonso           

Abstract Details

Purpose:

To evaluate the feasibility of accelerated bilateral complete visual rehabilitation in Fuchs´endothelial dystrophy with concomitant cataract over the course of one year. Descemet Membrane Endothelial Keratoplasty (DMEK) was combined with Phacoemulsification in simultaneous and separate procedures.

Setting:

Instituto Universitario Fernandez-Vega, Oviedo, Spain

Methods:

Prospective observational case series study. From a larger prospective group of 170 consecutive DMEK grafts, a selection of those which were performed in an time interval equal or inferior than nine months was performed. The period for full visual rehabilitation with maximum BVCA (decimal) was considered 3-6 months after the graft, and bilateral full rehabilitation was limited at no later than 12 months since the initial surgery. Implanted Endothelial Cell Density (ECD), residual ECD at 6 months and percentage lost were also recorded.

Results:

10 paired cases met the selection criteria. 6 males and 4 females aged 62.1±5.8. Preoperative BCVA was 0.53±0.31; improved six months after each graft to 0.93±0.12. Implanted ECD was 2852,4±227.3 cells/mm2. At six months it had decreased by 35,9±12.4% , resulting in 1832.19±232.18 residual cells/mm2. The sequence of surgeries were: 40% simultaneous PhacoDMEK followed by consecutive Phaco and DMEK in second eye; 40% simultaneous PhacoDMEK in both eyes, and 20% sequential Phaco followed by DMEK in both eyes. Only one simultaneous case (10%) required a precocious successful regraft. 0% rejections. 10% limited visual potential due to macular pathology.

Conclusions:

Accelerated bilateral complete visual rehabilitation in only one year is safe and effective for Fuchs´ endothelial dystrophy with concomitant cataract. Several strategies are equally effective with 2, 3 or 4 separate surgeries; Our recommended surgical sequence is: combined Phaco DMEK in the first eye, followed by phaco in the second eye 3 months after the successful initial graft; finally DMEK in the second eye three months later. Tissue availability is currently the limiting factor to achieve this accelerated approach.

Financial Disclosure:

None