Tips for Combining Phaco and IOL Implantation with DMEK

Drs. Arthur Okonkwo and Ahmed Bardan demonstrate phacoemulsification + IOL implantation + DMAEK explantation + DMEK with SF6 gas in a patient with a failed DSAEK. Near-clear corneal incisions with short tunnels were made so that the inner aspect of the wound did not affect the placement of the graft. A cohesive ophthalmic viscosurgical device was then used, as dispersive is harder to remove and may become trapped in the interface between the graft and the host. During irrigation aspiration, the viscoelastic was thoroughly removed, and a capsulorrhexis <5 mm was performed to reduce the risk of the IOL prolapse and graft touch damaging the endothelium. A hydrophobic IOL was implanted to reduce lens opacification. A slightly myopic refractive aim was chosen, as endothelial keratoplasty induces hyperopic shift due to changes in posterior corneal curvature. Descemetorhexis/DSAEK removal was performed against a dilated pupil’s red reflex and the DMEK graft was then inserted, positioned, and tamponaded with SF6 gas.

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