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First Author: M.Naveiras SPAIN
Co Author(s): C. Lisa A. Meana J. Alfonso
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To evaluate the feasibility and outcome of combined DescemetṀs membrane endothelial keratoplasty (DMEK), phacoemulsification and intraocular lens (IOL) implantation in the management of concomitant endothelial disorder, shallow chamber and cataract.
Instituto Oftalmológico Fernández-Vega. Oviedo, Spain.
Prospective, nonrandomized, clinical study at a tertiary referral center. In a first group of 9 consecutive eyes of 9 patients with concomitant endothelial disease and advanced catarac, combined phacoemulsification, IOL implantation and DMEK were performed. Grafts were inserted with an ICL injector, encapsulated within viscoelastic plugs. Femtosecond laser assisted descemetorhexis was performed in one case. Main Outcome Measures were: Best spectacle corrected visual acuity (BSCVA), endothelial cell density (ECD) and intra- and post- operative complications.
The procedure was successful in 71.4% of cases. Two required a secondary regraft due to complete graft detachment and late failure. At 6 months mean ECD loss was 53.2ḟ22.7% with an absolute mean ECD of 1320.4ḟ715.1 cells/mm2. At six months, 100% of patients with good visual potential reached BSCVA of ?0.5, 66.7%?0.8, and 50% ?1.0.
The combined triple procedure seems to be safe and effective in the management of cases with concomitant advanced Fuchs endothelial dystrophy, advanced cataract and shallow chamber. Endothelial cell density loss beyond 6 months remains a concern. When the triple procedure is necessary, it is recommended to implant high-ECD grafts (>2500 cells/mm2).