DMEK combined with cataract surgery appears effective

This retrospective study in the July issue of the American Journal of Ophthalmology examined the functional and morphologic outcome of Descemet membrane endothelial keratoplasty (DMEK) combined with phacoemulsification and IOL implantation in patients suffering from endothelial dysfunction and cataract. The authors say the results indicate that this surgery, also known as advanced triple procedure or triple-DMEK, can routinely be performed in such cases, and the addition of cataract surgery to DMEK did not adversely affect endothelial function, graft adhesion or the likelihood of postoperative complications.

The study included 56 patients (61 consecutive eyes) who underwent triple-DMEK. The authors found that the BCVA results were "very satisfying," with the data suggesting comparability to DMEK surgery performed alone. Mean BCVA increased from 20/91 to about 20/31 three months after surgery and to 20/29 at six months. Eighty-one percent of eyes achieved six-month postoperative vision of 20/40 or better, with a mean BCVA of 20/29. The authors say it is conceivable that triple-DMEK is equivalent or slightly superior to triple-DSAEK with respect to BCVA.

Mean refractive spherical equivalent was 0.5 ± 1.8 D three months after triple-DMEK and 0.9 ± 1.5 D six months after the procedure. The authors say this seems to be slightly worse than published reports after triple-DSAEK, but because of a hyperopic shift, they chose a target refraction of -0.5 D, which was later observed to be nearly 1.0 D. The target refraction has since been changed. Mean ECD loss was 40 percent at six months, which they say is only slightly higher than in studies on DMEK.

They conclude that in contrast to the conventional triple procedure (penetrating keratoplasty combined with cataract surgery), triple-DMEK is not associated with significant changes of refraction or prolonged visual rehabilitation and should be performed in all patients with concomitant endothelial dysfunction and cataract. But whether triple-DSAEK or triple-DMEK becomes the method of choice remains to be determined.