Posters

Hitting the refractive target with combined vs sequential DMEK and phaco

Poster Details

First Author: F.Price Jr USA

Co Author(s):    M. Price                    

Abstract Details

Purpose:

Descemet membrane endothelial keratoplasty (DMEK) combined with cataract surgery and intraocular lens implantation (triple DMEK) achieves excellent corrected distance visual acuity (CDVA). However corneal changes complicate the intraocular lens power selection and this often results in suboptimal uncorrected distance visual acuity (UDVA). The purpose of this study was to compare visual and refractive outcomes achieved when cataract surgery is performed after DMEK with those achieved with triple DMEK.

Setting:

Price Vision Group, USA

Methods:

This was a retrospective review of data collected prospectively on 32 eyes of 24 consecutive patients who had cataract surgery after DMEK. Results were compared with previously reported data on 108 eyes treated with triple DMEK at the same center. The main outcomes were CDVA, UDVA, spherical equivalent refraction, refractive cylinder, and endothelial cell loss.

Results:

Median patient age was 50 years (range 44-68 years). The pre-phaco spherical equivalent refraction ranged from -7.5 to +3 D. The rate of 20/40 or better UDVA was 97% with phaco after DMEK vs. 63% with triple DMEK. The postoperative spherical equivalent refraction was within 1 D in 94% with phaco after DMEK vs. 50% with triple DMEK. Toric lenses used in 8 eyes with phaco after DMEK reduced median cylinder from 2.1 D (range 0.0-4.25 D) to 0.25 D (range 0.0-0.75 D). Endothelial cell loss was not significantly increased using a dual viscoelastic phaco technique.

Conclusions:

Although triple DMEK is more cost effective and convenient for patients. performing cataract surgery after DMEK produces significantly better UDVA and spherical equivalent refractions that are significantly closer to the attempted values. Reduction of refractive cylinder is also significantly more accurate when cataract surgery is performed after DMEK.

Financial Disclosure:

None