Descemet's Membrane Endothelial Keratoplasty and Phacoemulsification

Abstract

Purpose: To compare the outcomes of Descemet's membrane endothelial keratoplasty (DMEK) combined with phacoemulsification versus DMEK following phacoemulsification. Methods: In this interventional retrospective comparative nonrandomized case series study, patients with Fuchs endothelial corneal dystrophy (FECD) with either cataract or previous cataract surgery with intraocular lens (IOL) implantation were assigned to one of the two groups according to lens status. Group 1 included patients who had cataract and FECD and would undergo triple procedure (phacoemulsification with IOL implantation and DMEK), whereas Group 2 included patients who had FECD and had phacoemulsification with IOL implantation earlier and would undergo DMEK only as a sequential procedure. Results: Postoperative best corrected visual acuity (BCVA) in both groups at 1 week, 1 month, 3 months, and 6 months revealed a statistically nonsignificant difference between the two groups with mean logMAR BCVA at 6 months of 0.07 ± 0.18 and 0.07 ± 0.19 in Group 1 and Group 2, respectively ( P > 0.05). The drop in endothelial cell density by the end of the 6 th postoperative month was by 39.44% ±7.92 and 38.73% ±8.10 in the triple-procedure group and DMEK only group, respectively ( P = 0.005). Total postoperative complications rate and the rebubbling rate were statistically similar between both groups with 13.5% and 12.5% rebubbling rate in Group 1 and Group 2, respectively ( P > 0.05). Conclusion: Visual outcomes, endothelial cell loss, and rebubbling rate are comparable when DMEK is combined with phacoemulsification or when it is performed as staged procedure, without statistically significant difference in the outcomes.

Effects of Combined Cataract Surgery on Outcomes of Descemet's Membrane Endothelial Keratoplasty: A Systematic Review and Meta-Analysis

“…Seven non-randomized studies ( n = 1,414 eyes) reported the primary graft failure rate, which was similar between DMEK and “triple DMEK” (RD 0.01; 95% CI: −0.02 to 0.05; I 2 = 34%; p = 0.44; Figure 7A ) ( 21 , 34 , 35 , 43 – 45 , 48 ). There was no data available regarding primary graft failures among non-comparative DMEK and “triple DMEK” studies.…”

“…After excluding 96 ineligible studies, 36 studies ( n = 11,401 eyes) were included in this systematic review. These included 17 non-randomized studies comparing DMEK alone to “triple DMEK” ( n = 8,304 eyes) with a mean follow-up duration of 12.8 ± 15.9 months (ranged, 6–60 months) ( 21 , 22 , 34 – 48 ), 14 studies on DMEK ( n = 2,609 eyes) with a mean follow-up duration of 20.0 ± 21.9 months (ranged, 3–42 months) ( 49 – 62 ), and five studies on “triple DMEK” ( n = 495 eyes) with a mean follow-up duration of 8.0 ± 3.4 months (ranged, 6–12 months) ( 63 – 67 ). Studies included were conducted at The Netherland (12 studies), Germany (nine studies), United States of America (seven studies), Canada (two studies), Egypt (one study), France (one study), Italy (one study), Nepal (one study), Spain (one study), United Kingdom (one study), and a multicenter study (23 countries).…”

“…Eight comparative studies ( n = 2,799 eyes), which included 1,408 DMEK eyes and 1,391 “triple DMEK” eyes, reported the postoperative re-bubbling rate ( 21 , 22 , 34 , 35 , 39 , 43 , 45 , 48 ), Re-bubbling was reported in 316 (22.4%) DMEK eyes and 381 (27.4%) “triple DMEK” eyes. The meta-analysis demonstrated that there was no statistical difference between DMEK alone and “triple DMEK” in terms of postoperative re-bubbling rate (RD −0.06; 95% CI: −0.13 to 0.00; I 2 = 73%; p = 0.07; Figure 4A ).…”

“…Five non-randomized studies reported the development of CME postoperatively ( 21 , 36 , 44 , 46 , 48 ). The risk of CME was similar between DMEK and “triple DMEK” (RD = −0.00; 95% CI: −0.02 to 0.01; I 2 = 0%; p = 0.70; Figure 7B ).…”

Kataraktoperation beim Vorliegen einer Fuchs-Endotheldystrophie

“…The postoperative course following a combined surgery (triple procedure) is not, in principle, different to that following a procedure performed in two stages (first cataract surgery, then posterior lamellar keratoplasty) 42 , 43 . In an analysis of 882 surgeries, we found comparable graft survival rates, a comparable number of repeat air injections (re-bubbling), and comparable rates of endothelial cell loss.…”